Ms Mary Dunnion:

I thank the members. I will share the questions with Mr. Colfer.

Garda vetting only takes two weeks now, so the system has improved since the Garda vetting bureau was commenced. It would have been quite a long process before these efficiencies were put in place. That is the reason it was of grave concern to us that providers of services were not availing of Garda vetting in certain centres and, more worryingly, did not see the importance aligned to Garda vetting in the context of looking after vulnerable people.

In response to Senator Dolan, the registration cycle is determined by the Health Act which sets out the registration cycle. It requires a ministerial instrument to change that to five years for disability services. Once we achieve the five years in 2018, we revert to three years again because that is what the Health Act determines.

In the discussion paper we have presented, we make the proposal that the registration cycle should be eliminated. It does not mean that we do not inspect to ensure standards are being met, but we do not see the three year cycle as a cost benefit. It is an expensive process. We do not see that it is required and we believe there are different regulatory approaches that can be taken that would drive improvement much more efficiently than renewing registration as an inspection process. That is determined by the Health Act. It is not in the control of HIQA. Our proposal would be that the system would be looked at.

On the issue of institutionalised practices, it would be foolish for me even to suggest that it is an easy thing to address. The institutionalised practices are by those delivering the service and by those living in the service. We have seen centres where it has been addressed. The two key catalysts for change were that it was led by example in that the person in charge did not accept and did not concur with that type of practice, and that the person in charge had the courage to address poor behaviour in staff. While the two examples sound simple, I would not underestimate what it takes, and we would have the evidence in our inspections to support leading by example, good management, good governance, taking ownership of being in charge and the accountability that is assigned to it, showing what behaviours are not acceptable, and over time bringing about change. I am confident that we would have very good examples of centres that have reached compliance, where the staff have taken the ball and gone with it and changed the system for very vulnerable people. It was a good example of how regulation contributed to that change.

We regulate more than 600 nursing homes. I agree there is a model of care in nursing homes which is determined by the regulations which are set out by Government and we measure compliance against that standard. It is a very limiting model. I do not think it will be able to respond to the cares of ageing people with disabilities who will need more medical and nursing care than social care services. Members will be worn out from me talking about the HIQA paper, but I believe there is an opportunity to look at the model of regulation that Ireland is offering now. I do not believe the regulation of a facility and care within a building is a model that is in keeping with social direction and care policy.

We would hope that this paper would become a discussion document to begin to work towards. Regulation as a model is not suited to the emerging needs or indeed national policy of people being maintained at home and staying in their own home and being cared for by family and other carers. There is an opportunity to look at that. It will require a change in primary legislation and we hope that this would be considered by the Oireachtas in its consideration of the future of health care.

I can only agree with the points made by Deputy Durkan. We would concur completely. It is a very difficult situation and it is a major challenge for people emotionally, financially and socially to look after their family and carers at home.

The reason we think the overview report is important is that it gives a lens of health care, older person's disability and children's disability. While our lens does not cover all services, it shows there is an opportunity to integrate these services more. We can see the integration is not there and there are opportunities for it. That is why I believe it is a good lens, although we accept we are not looking at everything, just the areas that we have mentioned. I could not but agree with Deputy Durkan and I hope that, in future, health and social policy will begin to reflect the concerns he identified. HIQA personnel would be more than delighted to be part of that direction because it is essential.

I will hand over to my colleague, Mr. Finbarr Colfer, on the issue from the viewpoint of human rights and how, from an assessment approach, we look at them currently, accepting that legislative changes are required.