Ms Carol Grogan:

Covid-19 was hugely distressing for residents and their families. The same as many people in society, residents experienced huge restrictions on their freedoms, which directly impacted on their rights because they were not able to avail of day services, those who had jobs were not able to go out and continue to work and they could not visit their families. Like in many other areas, where visiting was permitted, it was window visiting or areas such as that. It was hugely impactful.

Over 2021, we have seen that in some cases, there was a slower return for some residents to be able to regain those freedoms and in other cases they were very much supported. We also saw that some residents found positives as a result of being at home more and developed new personal goals for themselves, such as learning how to cook or undertaking different tasks in the house and feeling very much part of their own home.

On lessons to be learned in respect of Covid, as we highlighted, remote oversight does not work. That is very much evidenced in the declining level of compliance in relation to governance and management. As we outlined, that directly impacts on other regulations, such as premises, rights, privacy – especially in congregated settings – the quality and safety of care and risk management and approaches.

It is hugely important to bring in safeguarding legislation, not just for those living in designated centres but for any vulnerable adult. HIQA has advocated for the introduction of safeguarding legislation that can work alongside the Health Act and the regulations and can work alongside the Assisted Decision-Making (Capacity) Act that is shortly due to be commenced.

On the issue of designated centres and the definition, in the current Health Act the definition of a designated centre is the premises at which care or support is delivered. In the papers that we produced in 2017 and again in the paper on regulatory reform in 2021, we are looking for a reform of that definition to include the service that is being provided to the person and not just looking at the premises in which the service is being delivered. That way, the provider for the service could be regulated. That would allow for innovation in terms of the types of centres and allow for the changing pace and ever-evolving social care. The needs of people with disability are different now than they were years ago and that will change into the future.

We do not currently regulate sheltered housing. Where we are looking at transitioning from congregated settings, for the most part that is into a new designated centre, that is, a centre that is registered by us. We will come out and inspect that centre before a person moves into it to ensure that it is appropriate. As I said, in some cases, some residents are supported to perhaps live independently with home support. However, the vast majority of people move into a smaller, community-based designated centre where they can live as part of the community and go out to the cinema, go to the pub, go for dinner and do the normal things that everybody else does. For the most part, in a congregated setting, they do not get as many opportunities to do those things. Residents reported through the forum that in congregated settings they had fewer opportunities to go out and be part of the community, whereas in community settings that was much more freely available to them.

On the public and private division, most designated centres are funded through section 38 or section 39. The HSE is a service provider also. We only have two private providers. In looking at the 2021 figures, we looked at the division between the community and congregated settings. However, after the committee meeting, I can send the Deputy the HSE versus section 38 and section 39 funded services.