Mr. Paddy Connolly:

On Senator Crown's question on advocacy in the context of reform, I am speaking in the area of intellectual disability and disability primarily. I am not experienced in the hospital sector. The NDA has stated that three quarters of the €1.4 billion it currently spends in the disability sector does not underpin the current policy model. In other words, we have segregated and institutionalised people over a long period in residential settings. Once people are taken out of their communities and segregated in that way, they are exposed to risk, abuse and a lack of choice and control over their lives. That reform programme has not been energised in recent years. We are talking about giving people control over their own funding in order that they can buy their services. I respect what SAGE is saying in that this should not be an authority announced overnight and we have to move towards this. I appreciate that and it has to be carefully considered. However, one of my issues with a step-change process in the delivery of advocacy is that we have large organisations that receive hundreds of millions of euro in Government funding. Over a long period they have not reformed. They have their heads in the sand and they have no desire to reform. Unless we put advocacy services and checks and balances into these organisations and compel change, they will not change over a long period. That is the question of reform.

In terms of Deputy Byrne's question on Áras Attracta, whether things have improved and what figures we are using, they were the 2012 figures reported in the The Irish Times. I do not have more up-to-date figures, but the Ombudsman has spoken about how complaints in Ireland are under-reported compared with other jurisdictions. We can safely say, therefore, that the numbers we are using are probably understated. In terms of Áras Attracta, if the CEO of the HSE is coming in later, it is important to say that very significant measures have been taken in terms of the centre itself and a number of other centres. Several measures have been put in place in a number of centres since the Áras Attracta scandal. Can we say with any confidence that it is not happening in any other centres? I am afraid we cannot because we do not have the checks and balances, advocacy and systems reform to say those abuses are not continuing today.

On Deputy Healy's question about what advocacy services look like on the ground, for us advocacy goes beyond the current conversation around hospitals and residential disability services. I will give one example. We have the case of a young girl whom we will call Sophie. She is in a school in the east and has been restrained, face down on the ground, more than 400 times in the last 12 months by three teachers. It is a case we are dealing with at the moment. She has challenging behaviour. We have very significant abuses outside the models we are talking about here, in terms of hospitals and so on, and we have no advocacy for parents.

To answer Deputy McLellan's question about how one gets an advocate, by and large, one does not. We have very under-developed advocacy supports in residential services and in the community, so families find it very difficult to access a service. That is where organisations like us and others come in. We cannot deal with the level of demand on our services to do advocacy work.

I have two last points. One relates to the confidential recipient. She should be accessible to others. We are the organisation that called for the appointment of a confidential recipient, so while we welcome the call, our difficulty is that if it is about a person picking up the phone to her, she will phone someone else on their behalf. It is not a systems change. It is an important intervention, but it is not a systems change. It functions if a person is fortunate enough to get to a manager or if the confidential recipient gets to a manager for them. It is a personal, one-on-one service and we cannot address the broad array of complaints and concerns that are in the system with those types of personal changes. We need an office and an infrastructure.

I worked in the area of migration for more than ten years. In terms of advocacy and the diverse nature of Ireland's society now, the issue is about cultural competence. Advocates have to be trained up in cultural competence. We cannot provide an advocate with every language for every community, so we need to build the cultural competence of advocacy services.