Ms Celine O'Connor:

There are multiple answers to this because it depends where the complaint is coming from and where the person is located. If it is a concern from somebody living in their own home in the community, we can access them with permission. We knock on the door and ask for permission to come in. There is no special legislation or law that grants us access. While we would look for legislation, we do not want social workers to be able to knock at a door at any stage and say they are coming in to have a look. That needs to be a judicial process because people's homes are their protected space. The complaint could also come from a public service. Social workers are often employed in many of our public services so there may be a social worker in those services or in one of the disability voluntary bodies that the person can access.

We have significant issues in the private services and particularly in private nursing homes. In the past there was a HSE elder abuse service which would go in if a concern came in. Oftentimes those were in the private nursing homes. When safeguarding was established, that seemed to change things because the process did not require direct social work involvement in the assessment of concerns about abuse anymore. Instead, social workers on the safeguarding teams had oversight of what the service was doing to protect people. There was a significant difference there. Since the safeguarding policy came in, HSE-funded section 38 and 39 services are meant to safeguard the residents of their services and let the safeguarding team know what they do. There is a paper process and a preliminary screening that is sent in. Within three days of the concern arising, the safeguarding team will review it, make comment on it and ask for more feedback and information to ensure that safeguarding plan is as robust as it can be. Ultimately, the service that reports the concern is responsible for safeguarding. In those services, there may be multidisciplinary teams or there may not be.

There may also be people who have experience of working in safeguarding or protecting. For many services, though, there was a steep learning curve when this was established.

I believe what HIQA is saying is that it is seeing improvements as services are coming to grips with the situation. Training for staff in recognising abuse has been very important. Before Covid, three and a half hours of face-to-face training was provided to everyone in all of the services. It is important all levels of staff be aware because it may be the porter, the cleaner or even the visitors coming in who see something. Unfortunately, training stopped during Covid. There is a 30-minute training video available on HSeLanD. It is useful and accessible to people, but the lack of face-to-face training where people have the ability to ask questions has been a concern.

Another concern for us is that, during Covid, the lack of visiting meant there was no family safeguarding, that is, those externalised who come in and ask what this or that is about. Sometimes, staff in an institution do what they are taught. That is normal. It takes an external eye to ask why we are doing something this way and if there is a better way of doing it. Professor Phelan spoke about person-centred care. When we ask staff about person-centred care, they sometimes tell us they got a coffee machine in the staff room and it was lovely, but when we ask whether the residents can use it, they tell us "No" because it is just for staff.

This comes down to services' understanding and the training they are getting about what person-centred care is and what abuse is. Abuse is when someone is being left for a long time, the bell is not being responded to and his or her needs are not being met. Abuse is when, instead of getting a 20-minute walk in the garden because he or she needs to use the commode, the person will miss out on a walk that day. Abuse is when people's money is being used to pay for things that have nothing to do with themselves. We have had services that have paid for units to be painted rather than for residents to go on activities or get new clothes.

There are many small types of abuse. We know about the big issues – the sexual and physical assaults – but abuse sometimes takes the form of very small issues, for example, units where milk and sugar are still added to pots of tea because that is the way one person likes it and it does not matter that someone else does not, so that is the way he or she is getting it. This culture in services is challenging.

It is great if a service has a social worker. We hope social workers will examine and highlight these issues, although that is difficult to do for a lone social worker working in a service. We have duty social workers on our safeguarding teams, which anyone can ring in to – the Garda, members of the public, the family, services or staff. If concerns like these are raised with the safeguarding teams, the teams will follow them up and contact the services in question. Whether they have direct social work contact is an issue, though. If it is a service, it will be asked what it is going to do about the issues raised with it. Someone in the community or a social worker from a safeguarding team will triage the situation and may knock on the door to ask how he or she can help. If it is a private nursing home, the services will contact it and look to engage with it, but there is no right of access and a private nursing home is not obliged to engage with the HSE services. It can thank us kindly for contacting it and raising the concern while telling us it does not need us.

During Covid, though, there seems to have been a significant change in this regard. Supported by HIQA, there has been far more contact and collaboration on ensuring people are safe regardless of where they live. That last point is key. Whether someone lives in a private or public nursing home, disability service, homeless service or prison, he or she should have the same rights as everyone else.