Mr. Finbarr Colfer:

First, as referred to earlier on, we found that most services were good services. While that might be a trite term, it reflects and acknowledges that there are many providers that are operating very good services. We may use language like "good standard" but the implication of that is they are actually listening to residents and providing a good service and it is important to recognise that. Regulation provides protection for residents against a cohort of providers and of services and this protection is required.

We call out issues and name them and that is why they are in the report because the providers need to be held to account. We also share that information so that other providers can be aware of risk.

With providers where we have a trend emerging, if across a number of services we have identified that similar issues are arising, and if there is a failure to have shared learning amongst the providers’ centres, we will see that as a governance issue at organisational level. While the regulations require us to look at centre level, we engage with providers at organisational level. In quite a number of situations, therefore, including quite recently, we have brought providers in to meet with us and have told them that we are very concerned about the effectiveness of their own monitoring and surveillance of their centres, where they are not identifying where things go wrong and are not responding themselves.

We do that at board level. We call in the board, or representatives of the board of the organisation. Normally, those board members will bring senior executives with them. In those situations we have used what we call an escalated regulatory programme. We require those providers to review their governance arrangements and the effectiveness of these arrangements across all of their services. We require them to give us an improvement plan within a short period and then require them to implement that over a defined period, which is normally six months. During that six months period, we undertake sampling inspections across a range of their centres to look at how effective their actions are.

Sometimes providers give us an action that looks reasonable but when we go out on the ground, while that action has been implemented, it is only seen at senior levels and is not impacting on the lives of residents and we will challenge providers on that. We will also challenge them to link in with their residents to hear their views as part of that process. At the end of that six months we will then look at the effectiveness of the programme, whether we can find the provider to be fit, and whether their actions have impacted on the quality of the lives of the residents. We have undertaken those programmes with a number of organisations at this point.