Mr. Phelim Quinn:

There is probably a need for an increased focus on our preparedness for the demographics which include morbidity, illness and dependency profiles of our older population. The residential sector is playing an important part in addressing some of the issues involved, in particular end-of-life care issues. For individuals in nursing homes there tends to be a requirement for 24 hour, seven days a week, nursing care. From that perspective, we need to address the various levels of dependency and age profiles across the population.

We tend not to comment on the number of beds within the sector but rather the quality of the operation. However, if we are asked to ensure the facilitation of the entry of new beds into the system, we will do so, as I have outlined.

As I said in the report, there is a place both for announced and unannounced visits. In large part, public confidence calls for increased numbers of unannounced inspections. There is greater public confidence in the concept of unannounced inspections. In these instances, it is about inspectors trying to see services as they are delivered on a day-to-day basis, or, if we have received some unsolicited information, validating a risk. For example, it may be about providing care in the evening with reduced nursing and care staff on the floor. We check this, but there is no point in doing so on an announced basis.

The number of announced inspections we have undertaken this year has, to some extent, been based on the introduction of the thematic programme. The programme is about promoting improvement in the sector, for which we provide information by way of guidance to point them in the direction of best practice. We then follow through on their self-assessment to ascertain how they are achieving the relevant standards and regulations. The announced inspections are about ensuring an improvement in services and working with the sector to achieve that improvement.

Deputy Seamus Healy asked me about the public versus private care issue and whether we treated either category differently. We register at the level of the designated centre. Whether public, private or voluntary, the designated centre is regulated in exactly the same way. We do not treat any sector differently because we are assessing compliance with standards and regulations. Therefore, we deal with them in exactly the same way.

The Deputy also asked about environmental standards. As a regulatory body working alongside care providers, HIQA wants to see progressive realisation of higher standards of care in the environment within which it is provided. A number of targets were included in the original regulations for the achievement of specific environmental standards in the provision of care. Last year HIQA issued a regulatory notice which helped to explain better to providers in all sectors how these standards could be met. The main driver of improved environmental standards is the dignity of, and respect for, residents. In the regulatory notice we have given advice on how this can be achieved within some of the older buildings.

Deputy Catherine Byrne asked about the quality of the environment, in terms of the decor. There is certainly a requirement for providers to maintain a good standard in this regard. For however long someone is there, it is his or her own home. We believe his or her quality of life is influenced by the quality of the environment. Therefore, we have significant standards to be achieved in updating the environment where required.

Deputy Robert Dowds asked about activities within homes. This is a key issue that probably needs a further follow-up concerning the quality of such activities engaged in, including those which are therapeutic, in particular homes. In this and subsequent years we want to focus in our thematic work on areas in which a significant improvement is needed. They include not just areas that involve a high risk but also areas in which activities can be engaged in to enhance the quality of the residents' lives in homes. That is challenging within the residential sector.

The Deputy also asked about the independence of residents. On the person-centred theme, there must be a requirement to address the independence of residents in nursing homes in order that they can go out and engage in social activities in the community. This should be facilitated as part of the person-centred theme in the provision of care.