Professor Cillian Twomey:

In my view it is correct. The policy decision was taken two or three decades ago to essentially move the oversight of care for older people in residential care settings from a State-controlled one to a slightly distanced one. Twenty years ago, 80% of all residential care facilities were publicly run while today the percentage is exactly reversed. When I was in clinical practice some time ago, that is a policy decision I did not support. I believe that decision needs to be reviewed because one of the consequences has been an inevitable separation from oversight by State structures such as the Department or the HSE by virtue of that new arrangement, where one has independent private providers providing care without any formal structure of communication. We have addressed that in the report and stated it is absolutely essential that some form of connection be established immediately by means of a memorandum of understanding of some sort and, formally, a more firm and permanent arrangement whereby that separation of responsibility is no longer a reality.