Mr. Tony O'Brien:

I thank the committee for the invitation to attend this evening. I am joined by my colleagues, Mr. Pat Healy, national director for social care; Dr. Philip Crowley, national director for quality improvement, and Ms. Marion Meany, head of operations and service improvements for disabilities within the social care division.
Áras Attracta, which is located on a 13 acre site in Swinford, County Mayo, is a residential respite and day service for adults with an intellectual disability. It currently provides 100 residential places, 95 for residents and five respite places. Áras Attracta was the subject of a HIQA investigation and report in February 2014. This followed on from information received by HIQA, including information on the death of a resident at the centre. On foot of the report, HIQA made 59 recommendations. All of the recommendations have been implemented, including a significant programme of training and development for staff. There have been 423 hours of training to date in 2014, including over 100 hours in bungalow 3, which was at the centre of the "Prime Time" report. Training in relevant topics, including amongst many others adult protection, crisis prevention and intervention management, care planning and trust in care, has been implemented in the facility by the HSE. The facility received positive reports from the regulator on subsequent unannounced visits in May 2014, who clearly stated that:

[I]nspectors found the provider and person in charge with the support of staff had significantly improved practice in relation to these areas and the specific issues identified on the last inspection had been addressed. The inspectors also found that in response to a required action from the previous inspection, the provider had put in place an effective management system and this had resulted in a significant improvement in the provision of quality and safe care for residents.

It is therefore a matter of the most serious concern to the HSE that the totally unacceptable behaviour and attitudes towards residents, as seen in the RTE footage, continued in bungalow 3 until the allegations were uncovered and made known to the HSE.
The HSE became aware of the situation in bungalow 3 on receipt of a formal letter of complaint from a student on work experience placement at the centre. The student worked in the facility for ten weeks from September to November, including three weeks in bungalow 3. The HSE immediately acted on the written complaint. Subsequently, it emerged that the student was an undercover reporter for "Prime Time" and the producers in RTE have told the HSE that it took a number of weeks and the placement of a fixed camera before any unacceptable behaviour became evident. This highlights the challenges in detecting such unacceptable practices, attitudes and behaviours. Once the HSE became aware of the serious allegations, it initiated an immediate three-level set of actions as follows. At the first level, the most immediate priority has been to guarantee that a safe and caring environment exists for the residents of bungalow 3. A number of immediate actions have already been taken at Áras Attracta. Personnel against whom allegations were made have, without prejudice, been put off duty. A total of 13 staff have been put off duty. An Garda Síochána and HIQA were notified and Mr. Christy Lynch, chief executive officer of KARE has been appointed as independent chairman to conduct a full and thorough investigation into the matter.

A total of 13 staff have been put off duty. An Garda Síochána and HIQA were notified. Mr. Christy Lynch, CEO of KARE has been appointed as independent chairman to conduct a full and thorough investigation into the matter. Practice co-ordinators have been assigned to bungalow three to supervise practice and implementation of care plans and to provide assurance to management. External expert advice from Scotland, originally engaged following the first HIQA inspection, has now been re-engaged to support the service at Áras Attracta, responding to the needs of the residents at bungalow three.

At the second level, a full assurance review has also been commissioned of all of the units in the Áras Attracta facility under the independent chairmanship of Dr. Kevin McCoy, assisted by three independent experts within the field. This group will review the programme of work already implemented on foot of the reports from HIQA and HSE audits to establish their effectiveness, identify the gaps that arose and make recommendations for further improvements for each unit at Áras Attracta.

In addition, the output from the review team will help to inform a system-wide programme of improvement and assurance for all residential centres, including a mechanism for input from service users and their families and staff at all levels throughout the sector and academia will be involved.

At the third level, the HSE has initiated a system-wide programme of measures to assure that the quality and safety of services delivered by 90 providers in the 908 designated residential centres for people with disabilities is in line with the requirements of the regulations and standards as inspected by HIQA. In this regard, a six-step programme will be implemented and monitored by a national implementation task force for disability residential services, led by Pat Healy.

The national implementation task force will drive the implementation of the programme and development of long-term sustainable and evidence-based safeguarding practices and training programmes specific to residential settings.

Implementation of safeguarding vulnerable persons at risk of abuse - national policy and procedures - is the policy which is for all HSE and HSE-funded services and it builds on and incorporates existing policies in HSE disability and elder abuse services and in a range of other disability service providers. It will provide a consistent approach to safeguard and protect people with disabilities and older people from abuse and neglect. The policy defines the types of abuse and who is at risk of experiencing such abuse. It gives direction in the area of recognising abuse and how complaints can be made as well as the procedures to be followed to investigate any claims of abuse. A dedicated office for the implementation of the policy has been established, building on previous work undertaken in the area of elder abuse.

In terms of advocacy, the HSE will work in partnership with key internal and external stakeholders, families and service users to develop and implement a volunteer advocacy programme, similar to the model being developed for older persons and drawing on experience of other models of advocacy currently in use by disability groups. The HSE will support the development of service user-family councils that will concern themselves with the welfare of all residents and will seek to protect residents' rights and to enable them to participate in matters that affect their daily lives. These councils will be independently chaired and will empower service users and their families and will focus on quality development based on service user needs.

In terms of evaluation and practice improvement, this will involve undertaking an evaluation on the transfer of standards of care into practice in services provided by the 90 service providers which deliver residential services in designated residential centres regulated by HIQA. In collaboration with service users, staff, locally and nationally, will devise a quality improvement plan to support the sustainability of good practice throughout disability services around the country. The team has extensive knowledge and competencies in the area of intellectual disability and provision has been made to expand the team in 2015.

The recommendations of the McCoy review in respect of Áras Attracta and the broader system wide programme of improvement and assurance will be implemented. A national summit held today, which both I and the Minister of State, Deputy Kathleen Lynch, addressed, had participation not only from the HSE and the Department of Health but also from HIQA, the National Disability Authority, national advocacy services, the CEOs and senior management from the 90 providers, voluntary sector representatives and advocacy groups. The output from the summit will inform the work of the national implementation task force which held it’s first meeting this afternoon, following the summit. The system-wide reform programme will be included in the operational plan for the social care division in 2015 and further summits to review progress are scheduled March and June of 2015. The membership of the national implementation task force, the investigation team, chaired by Mr. Christy Lynch, and the assurance review team, chaired by Dr. Kevin McCoy, are available for the information of members.

Steps are also being taken for the appointment of confidential recipient for staff in HSE and HSE-funded services for vulnerable persons. I am pleased to announce that Leigh Gath has agreed to take up this important role. The role, of which the finer details have yet to be finalised, involves acting as a confidential recipient for whistleblowers, including staff and clients and their relatives and friends, in relation to safeguarding concerns and issues of alleged abuse, negligence or other mistreatment. Leigh Gath has been an objective critic of the HSE on disability matters over the past years. Both staff and clients can be reassured that she will be an important champion for people who may be concerned for various reasons when they make complaints. The terms of reference for the role are currently being agreed.

As director general of the HSE, I wish to put on record again that what was viewed on the RTE "Prime Time" programme falls well below the standards that we expect in the health services and displayed an absence of dignity, respect and human kindness for the most vulnerable citizens for whom we care. Such standards should not and will not be tolerated in the health service or the HSE. At the centre of many of these examples of poor practice is the individual responsibility of staff members. I urge all members of staff of the HSE, without fear or favour, to blow the whistle on any instance of misconduct, disrespect or abuse towards residents, clients, patients or any service user should they ever witness it. On behalf of the HSE, I again wish to apologise unreservedly to the residents concerned, to their families and to society more generally for the distress experienced at any time in relation to poor standards of care provided to them in bungalow three. This concludes my opening statement and together with my colleagues, we will endeavour to answer all questions members may have.