Ms Angela Fitzgerald:

I thank the Leas-Chathaoirleach. I wish everyone a good morning. I thank the committee for inviting us to discuss HIQA's financial statements. We will of course be happy to address the questions the Leas-Chathaoirleach raised.

As was already said, HIQA was established in 2007 as the independent regulatory authority. Our role is to enable the best possible outcomes for people using health and social services. Our legal remit includes setting standards, regulating public, voluntary and private health and social services and providing evidence to inform and support Government policy decisions. Protecting the safety and welfare of people using health and social care services is at the heart of what we do. Regulation seeks to provide independent oversight of the quality and safety of care and support and aims to drive continuous improvement. To put our role into context, the chief inspector regulates over 2,000 nursing homes and disability services. He also has a role in relation to specific aspects of children's services. In healthcare, we monitor the quality and safety of public and private healthcare services. We also have a role in relation to permanent IPAS centres.

It has to be said the primary responsibility for day-to-day quality and safety must rest with the service provider. Our role as the regulator is to ensure providers have systems and processes that are effective to assure themselves in the first instance that people using their services are getting the support they need and deserve. This is why governance and management are central parts of our inspections. This seeks to allow us to help providers move beyond simple regulatory compliance towards continuous improvement.

What have we done and how have we had an impact? It is fair to say that, in the lifetime of HIQA, we have driven a move from a medical to a social model of care in the area of social care and, in particular, a focus on a person-centred and human rights-based approach.

Often, the improvements achieved for people are things that we in society take for granted. For example, they mean that people living in nursing homes can exercise choice and autonomy in their daily lives and can enjoy privacy and dignity. In the context of disability, we have seen a significant move out of congregated settings into community. People tell us every day about the impact this has had on their lives. In children’s services, we have driven improved oversight and improved delivery of safety for those children who are most at risk. We also know that, as the regulator, we have much more to do. As the regulatory landscape changes, we have to adapt and change.

Other areas we are involved include setting national standards. National standards in regulation set the bar for driving continuous improvement. We also provide advice to the Minister and the HSE on the clinical effectiveness and cost-effectiveness of health policies and in respect of vaccination and screening programmes. One example was that during Covid, our team played a pivotal role in providing the evidence to support Government in making rapid decisions on public health issues. We work collaboratively with the Department of Health on informing national health information policy and digital health policies. We are currently developing an ethical framework for AI, which is rapidly coming into health and social care.

Listening and responding to people, taking the Leas-Chathaoirleach’s point, has to be part of what we do every day. We listen to residents, patients, families and inspections but we also try to use our voice to advocate for policy or regulatory change, and we can talk about that today. One other way that may not necessarily be associated with HIQA is the national care experience programme. This is a unique national collaboration between HIQA, the HSE, the Department of Health and patient advocacy groups. The findings give us clear insights as to what matters to patients and their families and allow us to help service providers drive those improvements. We also work with the Department to try to look at structural or other issues that might improve the experience of residents.

Our organisation is 18 years old. Our chair often describes us as a teenager organisation. Our remit has grown significantly under successive Governments. In the past two years alone, as evidence of that rapid expansion, we are now moving into monitoring private hospitals. We have a role in relation to international protection, we were asked by Government to review the mid-west in terms of urgent and emergency services. We have contributed significantly to the work of the Department and the Law Reform Commission in the area of adult safeguarding. We drafted standards for home support services that will be the bedrock of the regulatory framework that is coming. We recently assumed responsibility for the national immunisation advisory committee. As mentioned earlier, we published a review on the use of non-CE springs in children. We have also been asked to take on a role with regard to critical entities resilience, which is how we protect the State against external shocks.

On the matter at hand today, namely financial resources, the C and AG has already mentioned some of the areas involved. As a result, I will be brief. It is important to note that we have strong internal controls, overseen by our board, to ensure that our spend is fully aligned with the allocations we get. We are committed to ensuring high standards of corporate governance and compliance, and we have secured and retained our ISO accreditation. We have effective and constructive engagement with the Department of Health to ensure our resources are appropriate for our remit and are used appropriately. Our budget increased by 11% on the previous year. That is a clear reflection of our expanding remit and of the constructive relationship we have with the Department.

The C and AG referenced our spend. Like other organisations, 75% of our spend goes on staff costs. We always operate within our approved allocation and all new positions are sanctioned by the Department. Our staff are committed to making a difference to everyone we serve. As CEO, I am proud and I am struck every day by the strong sense of unity of purpose, shared values and passion among our staff. We invest significantly in our people to ensure that we maintain that sense of purpose as we grow and diversify. Critically, we must continue to attract, develop, promote and retain high-calibre staff.

One of the big enablers for us as a growing organisation is digital solutions, and this is very much aligned with Government policy. We have committed to move to digital platforms to allow us to take on new functions, to optimise our research capability and to make sure that, in the regulatory space, we have real-time access to data analytics, which will inform our regulatory approach but also will allow us, between inspections, to look at surveillance of services. We all know about the threat of cyberattacks. For us, as a regulator, protecting our systems and our people against external attack is critically important. Therefore, we have invested in the development of a multi-annual digital strategy, which we hope will ensure that we are an agile, fit-for-purpose and secure organisation.

As the Leas-Chathaoirleach stated, we must be always open to improving and learning. What was broadcast on the “RTÉ Investigates” programme was truly shocking and should never have happened. I apologise again to those directly affected and to anyone who feels let down by us, as the regulator. I assure the committee that we are taking regulatory action with the nursing homes operated by this provider group. We are working closely with the Minister and the Department on those areas where the regulatory and policy framework can and should be strengthened. We are also engaging directly with families and residents.

It is also important that we look at ourselves. We are committed to strengthening our regulator role and its impact. We are also committed to looking critically at how the approach we have allows providers, in the first instance, to assess their own leadership, culture and behaviour and lets us look more closely at that, allows us to leverage the use of data through regulatory reform to support ongoing surveillance between inspections and allows us to amplify communication with the public about what we do, how we do it and areas in respect of which we can learn.

I thank members for inviting us to speak to them on our accounts but also on wider issues. I know I speak on behalf of our board and all our staff in reiterating our shared commitment to developing the very best outcomes for all who use our health and social services. We want to be the trusted regulator. We know there are challenges based on recent events but we will seek to work with all of our stakeholders to drive continuous improvement in the overall experience of people using our services. We are happy to take whatever questions members may have for us.