Ms Rosemary Smyth:

We were asked about the Government's accountability and devolution from the perspective of the Mental Health Commission. Since the commencement of the 2001 Act in 2006 we have seen several iterations of governance structure within the public sector. We do not see similar structures in the private sector, which we also regulate. We have gone through several people who are responsible. There have been occasions when we did not know who was responsible and accountable, although the Act provides for a registered provider or proprietor. In the case of the public sector, this is the director general of the HSE, who devolves down the function.

That can be devolved down to anybody the director general deems fit to be considered for the role, and it can be at different levels of authority. The person does not always necessarily have the remit over funding, for example. Therefore, he or she does not really have the authority to exercise any change within their remit. I was asked for an example of that. It can be clearly seen in the inspection reports and the levels of non-compliance within the different CHO areas. Even within the CHO areas, the disparity of compliance levels within the regions will be seen. It is one service that is provided by one provider and the question must be asked why in one area a service can be compliant and people can receive a good quality service while down the road people are not receiving the same type of service, despite the fact that it is the one governor and the one commissioner of that service. This is why we ask and advocate for a national office for mental health with oversight of and responsibility for the delivery of mental health services.

We would also advocate in the area of regulation. The Act and the regulations do not provide for us to have oversight of governance arrangements, which would be unlike our sister regulator, the Health Information and Quality Authority, HIQA, and also unlike other jurisdictions that have such statutory regulatory oversight for governance.