Ms Mary Dunnion:

I thank the Deputy for her questions. I will share them with my colleague, Ms Eva Boyle, who will deal with the questions specific to the reports as she was one of the leaders in the inspection teams in that regard.

I will go back to the question in the context of regulation. HIQA has a legal remit and the only services we formally regulate are older persons and disability services. We regulate those services through a statutory instrument with the regulations determined by the Government. The standards against which we monitor are mandated by the Minister for Health or the Minister for Children and Youth Affairs, depending on which area is being referred to.

HIQA has been regulating for ten years and I genuinely believe - we have the evidence to support this - that regulation is a significant contributor to improving quality of care and safety for vulnerable people. The difference between where we are with children's services and with regulated services is that within a regulated service, one has powers. The powers allow us to ensure that an action happens because the regulated entity is licensed and registered to deliver that service, which is dependent upon them being compliant with the regulations. It also gives us instant powers when we come across significant risk. These powers are such that we can go as far as prosecution, we can close the service if we feel it is so unsafe or we can impose conditions that the service must put in place. These fundamentally are the differences.

The best example is probably the most recent one of disability, which actually concerns disability for both adults and children. Because that is covered, there is regulation in respect of the disability service for children and we can see evidence of an improvement in the lives of very vulnerable people in institutions. The Act refers to the institutions where these people have been for long periods of time. During our inspections we have spoken with approximately 10,000 vulnerable people and they have begun to articulate how things have started to improve. Regulation is a significant contributor to that.

There is, however, a limitation in that it is not and should not be the regulator's job to deliver the service. The responsibility of delivery rests with the provider of the service and this must always be the case. This is why we forever talk of the importance of governance and management. Where one has good services, there is good leadership and a good framework that is always watching to make sure it is safe. This is a really critical piece and this is why we emphasise it.

We believe such regulation should be in place in children's services. Children's residential services are due to come under the remit of regulation in a legal framework in January 2018. We are working with the Department of Children and Youth Affairs and have a workforce plan with the Department of Health in that regard. That will, hopefully, happen in this timeframe. We feel this is a really good step. We also feel that foster care services should be regulated. The safety net of regulation does not mean that one can walk away and say the service is 100% safe; terrible things will always happen. It is worrying to see the same themes reoccurring between 2013 and 2016 and this is why, right through our health and social care services, we see it as a challenge to learn from our mistakes, to investigate them in a timely manner, to learn from them and to make sure the learning is spread right across the service. This remains a challenge.

HIQA is very much in favour of the regulation of foster care services and would certainly present to the committee our desire for this. I shall put it into context. Children's services have 14 inspectors. The Deputy asked why HIQA was not in private care services. We have 14 inspectors and a total staff of 16 in children's services for all the areas we referred to. We did 48 inspections in 2016, we met more than 600 children, their families and people who work in the services. That is the reality of the resources in HIQA around which we must plan our services and inspections.

In foster care, however, what we have learned is why we are taking a new approach this year. This may answer some of the questions asked by the Deputy. If we can make sure that foster carers are assessed, trained and supported and that nobody works on the assumption that because they were good at the start they are still good three or four years later - then we would see this as a very fruitful approach to take now. This is why we have changed to the thematic we mentioned our review.

With regard to understaffing, there is a resource issue. There is no point in us saying that there is not a resource issue. The resource issue is in respect of both social workers and the numbers of foster carers. There are not enough foster carers and this is imperative. Fostering is such a marvellous thing to do as a service to provide for children. There is an imperative that Tusla and other agencies make sure that foster care is an attractive option and that if a person is going to become a foster carer, he or she is assured that he or she will be supported, will have the proper training and will know there is a monitoring of the service he or she is providing. We see gaps in that provision currently. It would be foolish and wrong of us to say there is no resource issue. There are not enough social workers within the service currently and that is definite.

Deputy Jan O'Sullivan asked about Tusla. There is a huge concern about the information systems, or the lack of them, within Tusla. If we go, for example, into a regional area for foster care services, one office will have an IT system and another will have a paper-based system. The actual transfer of information is stymied before it begins. It is very difficult to deliver an effective service with that kind of system in place.

Before I hand over to my colleague, I will refer to the issue of escalating risk about which everybody, quite rightly, is hugely concerned. As an assurance to the committee, when our teams go into any area where there is an immediate risk, we do not leave unless that immediate risk is addressed. That is the key principle from where we are coming. Thereafter, we go into a formal escalation process where we put our concerns in writing, along with a timeframe of when Tusla must reply to us and with the timeframe we set out who is the accountable person for the action. We, of course, inspect. Where we see a risk we will always go back to make sure it has been mitigated.

My colleague, Ms Eva Boyle, will now cover some of the specific areas of the two sets of questions and the most recent foster care reports.