Ms Angela Fitzgerald:

I thank the Cathaoirleach and members for giving us the opportunity to be here today. As the Cathaoirleach noted, it is a very difficult time for people living in nursing homes, that is, not just the two nursing homes referenced in the RTÉ programme but all such homes. It is incumbent on us to account to the committee and the public for how we do our work, what happened in these cases, what our response is and, critically, what we will do as we go forward.

As a human being, a daughter and a member of society, I reiterate my deep concerns about what we witnessed. The conduct of some staff and the behaviours witnessed were wholly unacceptable in any circumstance. I know, because I have done it for my dad and mam and, more recently, for my father-in-law, that the decision to place a loved one in long-term care is one of the most difficult and emotional decisions a family will make. It involves handing over a loved one to an entity to mind them for their remaining days. Nursing homes are entrusted by families and the wider public to take care of our older citizens, who have made their contribution to society and have a right to be taken care of at this time with dignity and respect.

The RTÉ programme raised shocking and deeply concerning issues, which we will seek to address today. Fundamentally, what we witnessed was a breach of basic human rights that can never be condoned in any circumstances. I recognise that the public and residents may feel let down by the nursing homes and, indeed, by us. We have to account for our role as a regulator, how we do our work every day and how we can do it better as a result of what has happened. I hope we will have an opportunity to explain that to the committee and to account for ourselves.

In circumstances like these, it is really important that there be an immediate response. Our first response must always be to ask whether the residents are safe and what we can do to make them safer in the circumstances in which we find ourselves. I am joined today by our chief inspector, Mr. Finbarr Colfer, and our deputy chief inspector, Ms Susan Cliffe, who have a statutory responsibility of direct accountability to the Oireachtas for carrying out inspections.

They will have an opportunity to explain for us all how that work is carrying on. By way of an immediate response, we conducted immediate unannounced inspections in the two centres over a number of different times: in the evening, early morning and late at night. We will explain later why we did it in that way. We also insisted the owners, who are not the providers, meet with the chief inspector as a matter of urgency to account for what happened and to take action. Both providers were issued with an immediate warning of the potential cancellation of registration if they failed to comply with any actions we required of them. More recently, through engagement with the chief inspector and myself, we agreed with the nursing homes to restrict admissions in all of their nursing homes, which total 23, for a period of four weeks to allow them, in the first instance, to be assured that all is well, but also to allow us to assess their ability to assure themselves. That is an important point which we will come back to today. We are the second line of defence when it comes to care. The first obligation must always be with the provider. In asking them to assure themselves, we will look at what they are relying on in that assurance.

Some of the immediate actions were designed to be immediate. We also need to say that this must be sustained. Ms Cliffe and Mr. Colfer will talk about circumstances in which immediate actions are taken and there is an intervention, but there is a need for a sustained response. This was so serious that we took action to inform An Garda Síochána. We will tell the committee about how we do that in other circumstances. We do it on the back of certain notifications. In this instance, we felt what we witnessed merited that action. An Garda Síochána will take its own action, but this is something we have done. We have also asked RTÉ to give us all of the footage because it may have more information than we currently have. We need to be able to see it to ensure that every resident, not just the people on the screen, are safe. RTÉ has agreed to co-operate with us in this regard and it is hoped it will be able to provide the information we need.

At a time like this, and I refer back again to being a human, Mr. Colfer and I were in the nursing home, and Ms Cliffe and her team carried out inspections there, we took the time to sit with residents and their families. It is important to say that a lot of families had good things to say about their experience. Most of them were anxious about what happens when they are not there and how they will know that all is well when they are not there. We share that concern. We took the time to listen to the lived experience and to observe what it is like to live in a nursing home. It is their home, and we are trying to make sure it feels like home, with all of the safeguards in place.

Emeis Ireland, which is the owner, has co-operated with us fully. It has taken the actions, opened the doors and agreed for us to meet with it on any basis we need. We do not have a legal role with Emeis Ireland. We do not have that role, which is something we will talk about later. Notwithstanding that, it and other providers typically work with us every day. What we want to be able to see, in circumstances where things go wrong, that additional powers are provided. We will come back to that later.

We talk a lot about governance and management. What does that mean? What they simply mean is that providers have systems and arrangements in place to allow them to know their arrangements are safe and they deliver safe, effective care. We have a secondary obligation, which is to assess their systems of governance and management. We do that. Members will see that, in all of our reports, it is something we look to because poor governance is usually an indicator of poor care. What this programme and these events have amplified is the importance of culture. While we look at that as part of our process, it is harder to see. What we saw in the programme is that, where people choose to behave in a particular way, they will not do that when they are being supervised or when we are there. We have to look beyond what we currently look at to see whether we can look underneath the bonnet in terms of governance. Regarding our systems and processes, we look carefully at a range of inputs to give us indicators of that. Ms Cliffe and Mr. Colfer will talk about that. We have to see whether we can do more in this space.

We have talked in the opening statement about how we do that work. While I will not go into further detail here, we will take it through in the questions. We inspect and report against the quality and safety based on both those inspections and on notifications, concerns and protected disclosures. We conduct ongoing monitoring and compliance. We will share that information with the committee. We always engage with residents and seek their feedback directly. While we do all of that, in this situation, we saw what happened. We must, therefore, look at the rail guards we can put between inspections and in the wider sense. Ultimately, it is about how we hold providers properly to account. They want to do that with us and have said as much. We now have to see whether they can do it on a sustained basis.

I wish to talk about the impact of HIQA. I know questions are being put to us today, but I wish to speak to what HIQA has done in the past 16 years. Even in the debate, people have acknowledged that. We know we have contributed to making a real difference in people's lives. People tell us that directly. We want to be able to continue to do that. We always want to challenge ourselves to not sit still, but rather to move forward. This is a big challenge we are facing, but we must be open and willing to accept that challenge.

Most providers respond promptly and efficiently. We welcome the fact they take their responsibility seriously. Where providers do not respond, we have levers, which we will talk more about today. They include issuing warnings, following up with inspections, engaging with providers, seeking more information and, ultimately, cancelling registration. That is a big decision. It impacts lives. In the case of Beneavin nursing home, 70 people call it their home, of whom many say they are happy there. It is a decision we have to take carefully, but we cannot stand over a situation where there is unsafety . Where we see unsafety, either through our inspections or otherwise, we act immediately. We will talk more about that.

With regard to the two nursing homes, it is important to say that we identified issues regarding training, staff, supervision, governance and management. Our typical approach is to allow the provider some time to improve their performance. That is part of what the regulation does. We have done that in this instance. We will come back to that. It is important to say that there is a slight difference between the two centres. One centre showed weak, underdeveloped management. The other centre showed an issue with culture and behaviour. They are two different things which demand different responses. We will talk to the committee about that.

When it comes to the regulatory framework and what needs to change, we have advocated publicly in written form for changes. We identified changes that need to be made. Many of those have been made, such as to our enforcement powers, the time to give effect and our power to investigate individual complaints. We will talk about those aspects throughout this meeting today. A particular change is the power to seek information on an ongoing basis. While that may seem like a basic requirement, there were some restrictions on us and that is now changing, and that will give us more powers. We have examined, with the Minister and others, what else we need to do and we will come back to members during today's meeting in this regard. One aspect relates to the corporate entity we talked about.

We need to look at our ourselves. We need to ask how we can be better in this space and what we can do. We must work with providers to require them to look at how they co-ordinate clinical care so that they know every day that Angela, her mother or anyone else is safe. We must use the safe staffing frameworks. Staffing was an issue and we welcome the work the Department is doing in safeguarding and staffing. The safe staffing framework has been implemented in acute hospitals, which is giving us an objective lens.

We need to look at how we look under the bonnet. What else can we rely on? We have some thoughts which we will share with the committee today. Fundamentally, we would like to say we are really sorry to the families directly impacted and to the wider community. We know they feel they have been failed by the nursing home and, to some extent, by us. We want to be answerable for that and we want to work with them to make it better. We are open to hearing their questions and challenges to us.