Ms Tanya Ward:

As has been said, there are many good staff working in the system. That is my experience but the kinds of examples Dr. Thornton is describing point to a system in which staff have not been held accountable for their treatment of people. We are talking about a very exceptional set of circumstances in Irish political life in which one organisation was not subject to any scrutiny by any public body. This is the kind of stuff that happens ultimately. Organisational cultures set in. Moreover, institutionalisation is a factor. The staff in the system become institutionalised and embedded, and committed to the system. Bearing in mind the findings in the Ryan report and other institutional abuse reports, people working within a system really buy into it, try to reproduce it and hold on to it. Obviously, change is important within this space.

The other thing we came across when we were on the working group was the notion of care. There was a nearly constant battle. It was said that the Department does not do care, just accommodation. One would not get that if one worked in other areas or other Departments because there is an understanding that there is a vulnerable population requiring care. The change to the national standards is acceptance that care is now part of what should be offered. That is why we are keen to have the changes implemented as soon as possible. Whoever provides the service will have to have a care component and social care workers on site who can deal with people's needs.

Establishing HIQA's role will be key. Where HIQA carries out unannounced inspections, it absolutely does change practice. HIQA involvement is not expensive. We were trying to work out how much it would cost and went to HIQA to find out. When it had about 4,000 in the system, it said it would involve four inspectors and two administrators. This pointed to a cost much cheaper than we thought. All that would be needed, therefore, is a change to the health Act to give HIQA a role in this area. It has already dealt with accommodation for vulnerable people. It could take this on. It has already been involved in cluster-type accommodation and independent living. It has the expertise. It is very simple to do. If we give the providers a grandfather period, there should be no reason what I propose could not be implemented.