John Dolan (Independent) | Oireachtas source

I thank the HIQA team for being present today and for the presentation. Mr. Quinn referred to the knowledge and experience gained through the work and how it meant that HIQA was well placed to offer some insights into the systemic issues facing our health and social care services. Will Mr. Quinn elaborate on that?

I suggest there is a strong emphasis in the work that HIQA does on the care of people. Care is a core component of people being able to lead a decent life, but it is not the beginning and end of their lives, nor should it be. That is a pointer or hint in terms of what I am suggesting.

Mr. Quinn referred to how HIQA commenced the regulation of the designation of centres in 2013 with a view to all services being registered by 2016. Then he referred to how it soon became clear to HIQA that a significant number were not and so on. Where was the decision made that it could be done by 2016? Who made that decision?

Mr. Quinn referred to issues of poor governance, inadequate safeguarding measures, institutional staff practices having to be overcome and the need for courage, strong leadership and a commitment to changing the culture of an organisation. What things might be needed to shift the culture, given some of the points raised about institutional staff practices etc.?

We heard some input from Mr. Colfer about what I would describe as a hot bed system. Someone has a space and someone else is lodging there at times. I have no other way of describing it. I want to take that as an example and relate it to the issue of poor governance. How do I do that? I will refer to the Convention on the Rights of Persons with Disabilities. One of the articles refers in plain English to the right to a home of one's own and to choose with whom one lives. The convention does not go so far as to say that a person can choose who is in bed with him or her or who is in the bed when the person in question is not in the bed. The HIQA representatives know where I am going with this. To what extent does the spirit of the convention inform or become part of the narrative for HIQA in discussions with the service provider?

The HIQA opening statement went on to refer to the importance of the overview report published yesterday. Reference was made to how it highlights ongoing challenges faced in these sectors. The opening statement also emphasised that many people are receiving a good quality of service. The good quality of service relates to their care to a great extent. However, does the service lead to their having something of a dignified life? To what extent does the whole residential package make it difficult for someone to break out and get into life in some way or other?

I note the issue of respite for those over 18 years of age. I note several other points that have recently come to us in this State as evidence. In the past year or so we know that approximately 1,100 people under the age of 65 years are in nursing homes. HIQA representatives go into nursing homes wearing a different hat. What is the HIQA view of encountering people there who have disabilities and are under the age of 65 years? I put it to the HIQA deputation that if there had been a decent battery of services for these people when they were living in the community, the great majority of them would not now be in nursing homes. The members of the HIQA deputation know better than I do that many nursing homes are in sylvan settings rather than where someone can go out onto the high street.

The CSO has told us that poverty rates for disabled people have been shooting up in recent years. Thankfully, they are getting better for the general population. The recent social housing report shows that the figure has gone from fewer than 4,000 people on the social housing waiting list four years ago to a figure shy of 6,000 now. The recent report from the ESRI on employment is relevant as well. These are strong indicators suggesting that things are very wrong in the community.

It is like the fair deal scheme. If there is a statutory provision in one place, it has a tendency to suck resources and drive a bias one way rather than another. I know people and others know of people who had a fair deal application form shoved under their noses. These were young people with families. This happened because it could be resourced. However, what they really needed was to stay with their families, but that was not resourced.

The HIQA deputation referred to how continued absence of assurance in respect of the rights and needs of vulnerable groups had the potential to create new hidden populations in our country. I am keen to pick under that, as it were.

I will finish with one final point, since I am offending the tolerance of the Chairman. A member of the HIQA deputation referred to value for money. What are the three or four key areas of a service that HIQA has to examine to determine whether it is value for money, apart from the obvious cheap and cheerful areas? What else makes up value for money when organisations are providing a public service?