Mr. Mervyn Taylor:

It is true when HIQA says it does not have enough powers, but I want to comment on that. It is a bit more subtle. HIQA says it cannot investigate an individual issue. However, it can take the information provided to it into account at its next visit and may arrange for an unannounced inspection or visit. Anybody with a will can use the existing system to chase an issue and can ask questions in such a way that they can elicit answers or be dissatisfied with the lack of answers. In a way you are stretching what you have. Before you give more powers, use the powers you have. That is the first issue.

On the issue of the Minister having been given some powers, I was deeply involved in that. It related to the terrible conditions surrounding the death of a man called Ultan Meehan, arising out of care in a nursing home in the north east. It is said it is woolly. An amendment that came in under the patient safety open disclosure Act was influenced by those events. If the Minister can ask HIQA to investigate certain things, it should be possible to explore creating a class of things that could be investigated or making regulations in that regard. It is about using what you have in front of you to the utmost. The grave danger is that everybody rushes out saying to give more powers. Use what you have. That is the issue.

Another issue gets missed here. People are focusing on HIQA. The big issue is really the HSE and clinical governance. The biggest weakness across the whole sector, which is by and large now privatised, is the lack of any overarching clinical governance approach. For example, a consultant geriatrician in Galway or in Castlebar, County Mayo, is not in any way in a position to interfere or intervene in a situation of care in a particular place, although it is in a HSE region. In the regionalisation of the HSE, which came out of the Sláintecare report, it had no plans for bringing all nursing homes within the overall ambit of the regional health authorities or areas, or the local integrated healthcare areas.

The issues are complex but the issue of nursing homes in particular deserves its own special session. We are not just talking about whether they are owned by the Chinese, the Americans or the French. Some nursing homes that are part of the Orpea group were bought over the years from another group, which was Irish. I recognise their practices because I remember sitting in one of those nursing homes late at night with a deputy person in charge who was in tears about some of those practices. A special session on nursing homes really is needed.