Ms Laura Casey:

I thank the committee for the invitation to discuss the general scheme of the Bill. I am a principal officer in the social care division in the Department and I am joined by my colleagues, Ms Fiona Larthwell, principal officer, and Ms Nuala O'Reilly, assistant principal officer.

I would like to outline the background and rationale behind this draft legislation, before briefly addressing some of its main provisions. The purpose of the Bill is to amend the Health Act 2007 and enhance aspects of the regulatory framework for designated centres regulated under the Act. This includes residential centres for older persons, people with disabilities and children. The ultimate objective of these proposals is to drive improvements for people living in these centres.

By way of background, the Health Act 2007 established the Health Information and Quality Authority, HIQA, and the Office of the Chief Inspector of Social Services. It also provides for a scheme of registration and inspection of the aforementioned residential services and for the making of regulations and the setting of standards on safety and quality in these services. The chief inspector monitors compliance with these regulations and standards.

A key driver for the legislation is the Covid-19 nursing homes expert panel report. As the committee will be aware, the expert panel made a series of recommendations not only on the response to Covid-19, but also on reform across the nursing home sector. The legislation addresses two areas of recommendations within the report: first, the requirement to modernise and enhance the regulatory framework governing nursing homes and, second, the need for mandatory reporting of key data by nursing home providers. The need for reform of the regulatory framework has also been identified in a number of previous reports from HIQA.

It has been agreed that a programme of regulatory reform in the nursing home sector will be pursued on a phased basis, with initial enhancements provided for in this legislation. The intention is that these initial enhancements will span two thematic areas, providing for a broader suite of enforcement tools available to the chief inspector and the collection, sharing and publication of key data on designated centres. As part of a second phase of work, the Department will undertake a further, more comprehensive review of the regulatory framework in the coming year.

I now move on to the provisions of the Bill. On the first thematic area, enforcement, the intention is to introduce new enforcement powers for the chief inspector to issue advance notices and non-compliance notices and, if necessary, to obtain urgent orders through the courts. The main provision for this is set out under head 6, with related or consequential amendments under heads 7, 12 and 15. The intention of these proposals is twofold. First, the introduction of advance notices and non-compliance notices will establish a more proportionate and graduated set of powers and tools for the chief inspector, focusing on bringing a provider into compliance and driving service improvement, as opposed to current powers that are limited to attaching restrictive conditions to a registration or cancelling registration, which HIQA has described as blunt instruments. These proposals have been informed by practice in other regulatory areas. Second, the introduction of urgent orders will provide the chief inspector with a means to react more quickly and effectively to urgent issues where it is believed that there is an immediate, material, adverse impact on the health, welfare, care or safety of a resident. Head 15 will introduce a number of offences carrying a proportionate range of targeted penalties to ensure the effective operation of these new tools.

In addition to the introduction of these enforcement tools, a number of enhancements and clarifications to existing enforcements provisions are also provided within the general scheme. First, head 8 provides the chief inspector with the express power to remove a condition attached to a registration, removing the need for the registered provider to make an application on the associated costs.

Second, heads 9, 10 and 11 provide for a reduction in the timelines for registered providers to make representations in relation to a proposed decision by the chief inspector under sections 50, 51 and 52 of the Act, or to appeal a decision to the District Court under section 55. These sections relate to decisions to impose or vary conditions on registration or to cancel a registration. The intention is to reduce the timeframe from 28 days to 14 days. This will align with timeframes for other court appeal processes. Third, head 14 provides a definitive, clear legal basis for the chief inspector to enter a premises that is unregistered to inspect it, where he or she has reasonable grounds to believe that the business of a designated centre is being carried out on that premises. This will provide absolute clarity that the protections afforded to residents of registered designated centres are extended to those who are in centres that have not been included in the registration and accompanying inspection regime.

Turning to the second thematic area, that of the collection, sharing and publication of key data, given the nature of the nursing home sector, in particular, with approximately 570 separate, registered entities, the majority of which are in private ownership, regular collation of key data on a voluntary basis and in a timely manner can be challenging. We all know that access to good-quality data is crucial to support national policymaking and service planning. It is also the case that the publication of data can improve transparency, drive service quality improvement and support prospective residents and their families to make an informed choice regarding their nursing home care. The intention of head 4 is to provide for a new function for the chief inspector to establish and maintain a reporting mechanism for the collection of key data in relation to designated centres. Once collected and then pseudonymised, this data will be shared with relevant Ministers and relevant State agencies, including HIQA, the HSE and Tusla. This head also provides for the publication of prescribed data relating to designated centres for older people to improve service user choice and transparency in the sector.

As set out under head 17, the operation of this reporting mechanism, including the data that will be collected, shared and published, will be determined by regulations made by the Minister for Health or the Minister for Children, Equality, Disability, Integration and Youth, as appropriate. Given that responsibility for the designated centres concerned rests with two separate Ministers, two similar but separate sets of provisions are set out in this head. It should be noted that while the enabling provisions under head 4 will provide for the reporting of data for all designated centres within the scope of the Health Act, they will not apply until regulations are made for each type of designated centre by the appropriate Minister.

A small number of additional enhancements and clarifications are provided for in the draft legislation. Head 5 will provide an express provision for the sharing of information by the chief inspector with HIQA. Heads 13 and 15 will provide that it is an offence to provide false or misleading information to the chief inspector. Head 16 provides that in any proceedings for an offence under the Act, the burden of proof shall be on the registered provider who is relying on the defence of reasonable excuse.

While the impetus for the proposed regulatory changes has arisen in relation to nursing homes, in particular, it is intended that the proposed amendments, in the main, will apply to all designated centres covered by the Act. In concluding, it is important to reiterate that the ultimate objectives of these provisions are to enhance service provision and to improve the protections for residents and centres. We are also aware that any new provisions must be proportionate. The draft legislation has been informed by stakeholder engagement and developed with this principle in mind. Again, I thank the committee for giving its time today and we look forward to the opportunity to further discuss the proposals.