Ms Carol Grogan:

I thank the committee for the opportunity to discuss HIQA's overview report on the monitoring and regulation of designated centres for people with disabilities in 2021. I am joined by my colleagues: Mr. Finbarr Colfer, deputy chief inspector of social services, and Ms Ciara McShane, national operations manager with responsibility for disability services. My role as chief inspector of social services within HIQA is to use the regulatory framework to ensure people living in designated centres are provided with good quality safe care and support in an appropriate environment that enables them to live fulfilling lives. The Health Act 2007 sets out that services, also known as "designated centres", which are subject to regulation, include nursing homes, residential services for people with disabilities, and children's special care units. The Health Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children and Adults) with Disabilities) Regulations 2013 and the national standards for residential services for children and adults with disabilities apply to residential services in Ireland. These form the basis of my inspectors' assessment of the safety and quality of support for people with disabilities in designated centres.

At the outset, I acknowledge the work of this committee, including its recent publication on the participation of people with disabilities in political, cultural, community and public life. The report makes a number of important recommendations to support inclusion and participation in political, cultural, community and public life, and the role of active citizenship regarding people with disabilities in society. HIQA will utilise its role as an independent regulator to support a more active model of integrated living for people with disabilities, now and into the future.

The overview report for 2021 sets out the activities of inspectors and the learning from inspections during 2021. As at 31 December 2021, there were 1,401 registered designated centres providing residential support for 9,039 people with disabilities. Inspectors carried out 1,220 inspections in disability services in 2021. Our inspection findings are based on information we gather from a number of sources, including meeting with staff and providers, reviewing records and, most importantly, speaking to residents to hear about their lived experiences.

What we found during the 2021 inspections is that the majority of providers provide a good standard of care and support to people with disabilities. However, there is also a cohort of centres where providers failed to ensure the safety and quality of support for residents. In such instances, our inspectors took regulatory action to ensure providers improved the care and support being provided to people with disabilities.

One of the key areas of learning from the inspections in 2021 was the negative impact of declining levels of compliance with governance and management because of more remote oversight by providers during the pandemic.

As with previous years, the overview report outlines the clear link between well-governed services and safe quality services. During 2021, one in five inspections found that improvements were required to the providers' governance and management arrangements, with non-compliance increasing throughout the year, including in centres where providers had good oversight arrangements prior to the Covid-19 pandemic. This is an area that I, as chief inspector, have been focusing on during the current year. Many providers are now taking measures to re-establish strong governance arrangements.

Furthermore, during 2021 inspectors found that there continued to be significant variance in the level of non-compliance in congregated settings by comparison with community-based settings. At the end of 2021, almost a third of people with disabilities in designated centres were living in congregated settings.

HIQA found that people with disabilities living in congregated settings were more likely to experience a poorer quality of life, with notable inequalities in the overall quality and safety of the services being provided to residents. Furthermore, a higher number of congregated settings than in previous years required improvements to the overall quality and safety of the premises.

HIQA supports the national policy for transitioning people with disabilities from congregated settings to more appropriate community-based places to live and further work is required to ensure that this policy is implemented in an effective and timely manner.

In response to the Covid-19 pandemic, I, as chief inspector, commenced a programme of targeted inspections to assess registered providers' compliance with regulation 27, on protection against infection. The programme aims to promote continuous quality improvement in infection prevention and control, in line with the national standards for infection prevention and control in community services, issued in 2018.

Engagement with providers of disability services is critical to our work as a regulator. We continue to hold provider representative forum meetings and we are running a series of roadshow events with providers and persons in charge across the country next month.

The provider representative forum is made up of representatives from umbrella bodies, including the National Disability Services Association, the National Federation of Voluntary Service Providers, the HSE in its role as service provider, and the Disability Federation of Ireland, along with HIQA's deputy chief inspector and the national operations manager. The forum meets bimonthly. A range of items are discussed and information is shared. Items raised by representatives are discussed and considered and can result in positive changes for all.

This year we are re-establishing in-person provider roadshows in November. The title of this year's event is The Impact of Good Governance – Finding the "Rights" Approach. The provider roadshows offer the opportunity to engage with providers, persons in charge and people participating in the management of centres outside of the monitoring process and share valuable information. They also give providers the opportunity to raise questions they may have on key topics, such as governance and management, human rights and infection control. This year, we are delighted to be in a position to resume our face-to-face provider roadshows, which will be held over four dates in Cork, Galway, Dublin and Cavan. We look forward to seeing and speaking with attendees in the coming weeks.

I would also like to brief committee members of another aspect of our work. Spending time with residents, to listen to what they have to say and to observe what their day-to-day life looks like is an essential part of our work. Earlier this week, HIQA published a report entitled Resident Forums in Centres for People with Disability in 2021.

Over recent years, our staff have met residents in their own groups, in which they have their own supports and feel comfortable speaking to us. In 2021, due to the ongoing public health restrictions due to the Covid-19 pandemic, it was not possible to meet in person, as we had in 2019 and 2020. However, we continued to meet resident groups through online virtual meetings. Our report sets out what residents told us during the meetings. The feedback from residents reminds us all about what is important in the lives of people with disabilities living in residential centres. Residents told us about the improved quality of life for them when they moved to small, local, personalised homes in the community from a large institutionalised residential service.

Listening to the views of residents ensures that we can continue to focus on the requirement for providers to uphold the rights of residents and that the will and preference of people with disabilities are respected. We hope that by publishing this report, others will also listen to the views of residents and ensure these are used to inform their work also.

I assure the committee of HIQA's continued commitment to promoting and protecting the rights of people with disabilities to live in a safe environment. Our report entitled Overview Report: Monitoring and Regulation of Designated Centres for People with Disabilities in 2021 sets out a summary of our inspections and key findings. To further improve services for people with disabilities living in designated centres, HIQA believes meeting provider representatives and resident forums will help improve our standards and ensure better compliance across all regulations.

I thank members for their time and attention this morning. We look forward to answering any questions they may have.