Mr. Phelim Quinn:

I shall first answer Deputy Naughton's question on open disclosure. HIQA, as an organisation, is supportive of the concept of open disclosure and for having legislation that supports open disclosure. We have recently completed a set of standards on patient safety incident management. As part of the early development of those standards there was discussion on whether to include a reference to open disclosure in the standards. The Department of Justice and Equality has informed us that there is, although I am not sure of the exact name of the Bill, specific reference in legislation to open disclosure and that there are regulations that address some of the issues on open disclosure in the Bill.

Deputy O'Connell asked a question on the reference to the rationalisation of services in HIQA's opening statement. Let me put my comment in the context of the longer-term strategy on commissioning.

At the start I said that commissioning needs to be done in an incremental way and that possibly the best way to commence such work is to consider commissioning for the individual. If we reach the point of commissioning services for local communities, regions and national services, one of the critical components of a commissioning model is around the needs assessment for a population. We need to discover what nationwide services a population requires. Anything in and around decisions on rationalisation of service and the configuration of services needs to conducted on the basis of sound evidence and information. It was in that context that we made the statement on rationalisation.

In terms of a standardised framework to commission services, there is a very critical range of specifications that would inform a commissioning decision. Again, they would very much be based on population need. There have to be quality and safety metrics within a commissioning specification as well as financial and activity metrics. At the moment I am not sure whether all of that exists. In our experience, say in the commissioning of services for people with disability, there is block funding available but we would not necessarily see it broken down or know how the money has been assessed in the context of value for money.

I will pass the question on home care regulation to Ms Dunnion. I have experience of regulating home care services in another jurisdiction. Deputy O'Connell mentioned that a definition of a home care or domiciliary care service would be important factor in new legislation. I do not believe, within new legislation, that one should include some of the informal components of care that she mentioned. This is not about creating a nanny State that regulates care provided by relatives or people on an informal basis as commissioned by families. We must adopt an incremental approach in the first instance. As the Deputy has said, one sees many leaflets and advertisements by large companies that provide home care services. That is one of the first places where we need to start and, similarly, where larger organisations in the public and voluntary services provide services. We must analyse the systems that they have in place in order to ensure that the care provided is safe, effective and that people are safeguarded.