Jerry Buttimer (Cork South Central, Fine Gael)
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Today's agenda is the Health Information and Quality Authority, HIQA, corporate plan for 2013 to 2015. I welcome the new chairman of HIQA, Mr. Brian McEnery, and the head of communications, Mr. Marty Whelan. I thank them for attending and extend my apologies for the delay. Parliamentary democracy is wonderful, but it means we have votes which sometimes cause inconvenience for our guests. I apologise for that.

John Gilroy (Labour)
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This democracy thing is a little tiresome.

Jerry Buttimer (Cork South Central, Fine Gael)
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It is good to have it, however. Mr. McEnery is here to introduce himself as the new chairperson of HIQA and to discuss the priorities he and HIQA have in the corporate plan.

Before commencing I remind the witnesses regarding privilege. Witnesses are protected by absolute privilege in respect of the evidence they give to the committee. However, if they are directed by it to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected to the matters under discussion should be given and are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against a person or an entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice and ruling of the Chair to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable. I invite Mr. Brian McEnery to make his opening remarks.

Mr. Brian McEnery:

As chairperson of the board of the Health Information and Quality Authority, HIQA, I thank the Oireachtas Joint Committee on Health and Children for giving me the opportunity to address the committee. I am joined by the authority’s head of communications and stakeholder engagement, Mr. Marty Whelan.

HIQA operates as an independent authority reporting to the Minister for Health and to the Minister for Children and Youth Affairs, pursuant to the Health Act 2007 and other Acts of the Oireachtas. My objectives for the first three years of my tenure as its chairman are set out in HIQA’s corporate plan 2013–2015, which was approved by the Minister for Health on 12 September 2013 and laid before the Houses of the Oireachtas. I understand that copies of the corporate plan have been previously circulated to members for today’s meeting.

Before discussing the corporate plan, I would like to give the committee some background on myself and to outline my personal perspective in what I would like HIQA to achieve during my tenure as chairperson. Since qualifying as an accountant in the early 1990s I have specialised in the area of advisory services in health care. My first personal experience of health care delivery was gained while studying, and during summer holidays I worked as a care assistant in a psycho-geriatric home in the West Midlands in the UK. The experience was different for a young accountant but it helped define my professional accountancy life as one specialising in health care consultancy.

For the past ten years or more, I have provided financial, operational and strategic advisory services to acute, older person and primary care services throughout Ireland. I interacted with HIQA prior to joining the board and I have the utmost of respect for the role of the authority and the way in which the authority carries out its functions. I applied for the position of chairperson because I am passionate about the need for an independent health regulator having been a care assistant and an adviser to health care operators.

As chairperson of the authority I want to ensure HIQA continues to build on its reputation and standing as a regulator. The agenda of the authority is evolving to cover new areas on monitoring against standards which are applied in a risk-based methodology in a proportionate way.

I would like to focus today on HIQA’s corporate plan 2013-2015, the authority’s third corporate plan since it was established in May 2007. It builds on the achievements and impacts of the earlier corporate plans that have shaped the work of the authority to date. The development of the plan started in September 2012 and involved a review of the authority’s existing corporate plan and legal mandate, consideration of the internal and external environments and related priorities, our learning from our work over the past six years and the challenges and opportunities facing our health and social care system both today and into the future.

HIQA’s mission is to promote sustainable improvements, safeguard people using health and social care services and support informed decisions on how services are delivered. The mission will guide and direct all of the activities of the authority and the corporate plan clearly sets out the vision to achieve this over the next three years. It also outlines the priorities that will need to be met to enable us to meet our strategic corporate objectives during this time.

The corporate plan is the result of an extensive consultation process which ensures we are fully conscious of the external environment in which we carry out our work and enables us to plan accordingly. I wish to express my gratitude to all of those who took part in the process. I hope that the final plan, which commits us to working with our stakeholders in a collaborative and constructive manner, has addressed all of the issues raised during the consultation. The final plan reflects the authority’s core values of putting people first, being fair and objective, focusing on excellence and innovation, being open and accountable and working together with internal and external stakeholders.

As the authority’s chief executive, Ms Tracey Cooper, outlined to the committee last September, the role of the authority is set to expand considerably over the next three years. The corporate plan will enable us to carry out new functions as efficiently and effectively as possible while prioritising areas where improvements in services are needed most and providing increasing developmental improvement support to people providing services. The plan also provides a robust framework to ensure that we continue to carry out our existing functions to a high standard. As the work of the authority expands, the corporate plan will guide the incorporation of these new functions while ensuring that they are properly planned, are cost-effective and are adequately supported. This is particularly important at a time of economic uncertainty and ongoing reforms of the health service, which we are particularly conscious of, and these factors were taken into account during the development of the plan.

The corporate plan reflects HIQA’s primary focus of improving outcomes for people using our health and social care services. One key area is the continued growth in our regulatory functions for adults and children over the coming years, some of which will happen in previously unregulated areas. This includes the registration, oversight and scrutiny across a range of health and social care services for both adults and children, including the recent commencement of the regulation of residential services for people with a disability from 1 November 2013, and the move towards a health care licensing system. We will continue to report publicly on the safety, quality and effectiveness of health and social care services, enable the health and social care system to reduce the risk of harm and abuse to people using services, inform decision making on investment and disinvestment service-based decisions and share the learning from activities to ensure continuous improvement in the planning, management and delivery of services.

As well as working with external stakeholders, successful delivery of the new corporate plan will also depend on a number of internal factors. We have placed particular emphasis on these within the authority as a means of optimising the delivery of our functions in an efficient and effective way. Further development in these internal factors will enable our continued improvement in areas which include having a professionally competent and supported workforce; a robust and effective corporate governance structure; effective planning and performance management; ensuring our work is informed by evidence and research; communicating in an open and responsive manner with stakeholders; and using and managing information effectively and in accordance with best practice.

These key enablers will ensure our success in carrying out our four core activities of regulation, supporting improvement, improving outcomes through information, and health technology assessment. More broadly, we want to ensure that we use our talented staff and resources in the most efficient and effective manner in order to have the maximum impact for people using and delivering services and to inform decision making in a resource constrained environment. In doing so we will aim to continue to reduce the overall burden placed on service providers wherever possible while maximising our approach to safety and quality improvement. The authority will continue to work with other health and social care stakeholders in this respect. It will further develop memoranda of understanding with other key organisations, including other regulators, to ensure that patient safety and the broader public interest are always the priority.

Following on from these core activities, the corporate plan also describes the outcomes we aim to achieve for patients and people using services and the activities that we will implement in order to deliver on our statutory remit. The outcomes we aim to achieve are that care is improved, people are safeguarded, people are informed and policy and service decisions are informed. Also included in the plan are specific targets and timeframes to assess and measure the delivery of our strategic objectives and through which we can be held to account. The inclusion of a one page strategy map in the plan provides a concise illustration of the authority's strategy to achieve its goals up to 2015, while a far more detailed breakdown of the outcomes, core activities, strategic objectives and key enablers is also provided in the plan, which covers the specific types of work that we will be doing to deliver the plan and to make a difference.

As I have mentioned already, the development of this corporate plan took place in the context of a challenging economic environment and an ongoing programme of major system reforms in the health and social care sectors. It is likely that many of these changes will impact on the work of the authority and this plan will, therefore, need to be adaptable so that it remains relevant to the people who use health and social care services and ensures that HIQA's vision to drive high quality and safe care for those using these services is being carried out in an efficient, effective, real and relevant manner.

It should be noted that much of what is included in the corporate plan 2013 to 2015 is dependent on the implementation of Government policy. I thank the committee for the opportunity to discuss the corporate plan today and look forward to answering questions and hearing feedback from members. I also look forward to continuing to work with this committee over the coming years to collectively drive improvements in our health and social care services.

Jerry Buttimer (Cork South Central, Fine Gael)
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I thank Mr. McEnery for his comprehensive and informative presentation. I wish to pay tribute to the authority's chief executive, Dr. Tracey Cooper and thank her for her outstanding stewardship of HIQA to date. I also wish Mr. McEnery well in his position and thank him for being here today. I invite Senator Crown to respond to the presentation.

John Crown (Independent)
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Am I the official leader of Opposition today?

Jerry Buttimer (Cork South Central, Fine Gael)
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That is a sobering thought for the rest of us.

John Crown (Independent)
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Indeed. Democracy really is in action here. I thank the witnesses for appearing here today. I know a little about this area. As well as being involved in medicine, I studied health care quality formally at masters degree level in an MBA programme. What struck me about the formal study of quality is that it has little to do with quality and everything to do compliance, that is, compliance to a predetermined standard which is set at an arbitrary level of performance, against which those whose quality is being assessed can be measured. Unfortunately, these predetermined standards almost never include the actual outcome of the health care itself. That is why the society which has the most intensely regulated health system, the one which in many cases has acted as the poster child for HIQA-like model, namely, the United Kingdom's National Health Service, has such poor outcomes. Figures which have just been released by the OECD from a survey of cancer survival rates show yet again what everybody in this business knows, that is, if a system is desperately short of doctors, nurses and resources in general, the thing which will fix poor outcomes is not building another bureaucracy and throwing it at the problem. That is what the British have done and what we have done with the development of HIQA.

To me, the idea of having appropriate regulation is critically important and perhaps HIQA, in some other parallel universe, could provide it. However, the extraordinary disproportion between the focus of HIQA on process in individual hospitals, together with its complete and systematic neglect of the big picture, which is the bizarre nature and structure of our health system and the bizarre under-staffing levels we have, was perhaps best exemplified in the Savita Halappanavar report, which was very inadequate. I will not use any specifically derogatory term but it absolutely skirted around the key issue, which was not that there were poor processes in place but that a tiny number of trained people, in the most medically under-served part of the most medically under-served country in western Europe, in terms of the number of specialists per head of population, were asked to do a job that would have been done by six, eight or ten people in another, more normal, environment.

In truth, if at some stage we fix the health system, making the appropriate investment in it and reorganising its structure so that it behaves in a rational fashion, we will need regulation. We are putting the cart before the horse right now. What is happening - and I shuddered a little when I heard the description of how HIQA's regulatory tentacles are going to spread into every other aspect of health care - is that HIQA is in danger of becoming the armed wing of the HSE. That is what it looks like from my perspective and that worries me. I am very worried about one particular issue. In recent months I have become aware of mission creep with respect to the regulation of clinical trials, where HIQA is going way past regulation and will be managing those trials. HIQA is going to be setting up-----

Jerry Buttimer (Cork South Central, Fine Gael)
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We are dealing with the corporate plan today.

John Crown (Independent)
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Okay, sorry about that. I will be compliant again. I ask the witnesses to go away with one question. I know those in the agency mean well, but has HIQA ever saved a life? I believe not.

Jerry Buttimer (Cork South Central, Fine Gael)
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That is an unfair question.

John Crown (Independent)
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What is the opportunity cost associated with the existence of HIQA, with money spent on large public relations departments and corporate spokespersons? Such money could be redeployed, at a time when we are trying to find out how we can save money on cancer drugs. The fact that what we will spend in one year on cancer drugs the Government will blithely spend in three weeks on bailing out the banking sector indicates that our priorities are wrong.

Mary Mitchell O'Connor (Dún Laoghaire, Fine Gael)
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I thank the witnesses for the presentation. I know why HIQA was set up. We want quality assurance and no matter what individual doctors and other employees of the health services do, we were let down by those services, particularly in nursing homes. Is HIQA confident that the services being offered and delivered to older people in private and public nursing homes are now better and safer?

There has been some discussion recently about setting up new preschools. I previously worked in a school which provided an aftercare service, which involved giving food to the children. The first people to knock on our door were inspectors from the HSE, who checked the kitchens and so forth. Do the HIQA representatives see any role for the agency in terms of the delivery of preschool services?

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I am keeping an eye on the monitors because health business will be dealt with in the Dáil Chamber shortly, as happens frequently these days.

Jerry Buttimer (Cork South Central, Fine Gael)
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To clarify, this is an additional meeting, called by this committee. It is not the fault of the Whips that it is clashing with Dáil business.

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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I want to ask one question about resources. Has HIQA any input into the question of resources for the health services? If the agency is checking the standards in hospitals or health agencies and clinics, surely an important factor is the level of resources available in the particular hospital or health care centre. In recent years, over 11,000 staff have been taken out of the system-----

Jerry Buttimer (Cork South Central, Fine Gael)
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We are here to discuss the corporate plan, as opposed to-----

Séamus Healy (Tipperary South, Workers and Unemployed Action Group)
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This is relevant to the corporate plan. A total of €3 billion has been cut from the health budget. I am aware of a hospital near my home which has lost 25% of its budget and almost 200 staff members. Surely these are issues that crop up when HIQA is carrying out inspections and checking standards across the board in various health care settings. Is it reasonable that HIQA reports would not refer to the question of resources? As I understand it, HIQA reports do not recommend a particular level of funding, resources or staffing for the institutions it inspects. This is a huge issue. Does HIQA have a function in that regard? If so, what is its function? If not, should it have such a function?

This aspect should be addressed by HIQA and I would like to hear what our visitors have to say in that regard.

Dan Neville (Limerick, Fine Gael)
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I welcome Mr. McEnery and Mr. Whelan. It is clear that increased resources will be required if HIQA's plan is to be implemented. Have discussions taken place on how the resources needed to implement this plan might be obtained? Are the witnesses satisfied that these resources will be made available? We can have all the plans we like. They might look good on paper but that is where they stay if we do not have the resources to implement them. With the indulgence of the Chair, I would like to make the point that I would like HIQA to inspect psychiatric institutions as well. I know this is not directly within its remit at present. We are extremely concerned about the quality levels in some, but not all, of those institutions. I know that the Mental Health Commission, rather than HIQA, is responsible for this area. We have made some points in this regard over the years. I am very interested in what Senator Crown has said. Perhaps we will have a discussion on that at another time. Mr. McEnery might not want to comment on HIQA's role with regard to mental health and psychiatric institutions, but I would welcome some remarks on the issue.

Jerry Buttimer (Cork South Central, Fine Gael)
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I will allow Senator Burke to come in at this point because he will have to leave soon to speak in the Seanad.

Colm Burke (Fine Gael)
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I apologise for having to leave this meeting early, but I must raise an issue on the Adjournment in the Seanad. I thank Mr. McEnery for his presentation. I wish him every success in his role as chairperson of the authority. I believe HIQA is playing an important part in setting standards and making sure they are implemented. The question I would like to raise relates to an important report on this country's maternity services and the consultation that took place during the Galway investigation. Medical personnel from a certain institution have advised me that management at another hospital, which was regarded as not having implemented the recommendations in the Drogheda report, did not consult the medical personnel in that hospital before the reply was sent to HIQA. It was suggested that they had not complied with a recommendation in the Drogheda report. I have been advised that the recommendations in the Drogheda report had been fully implemented at the hospital in question. I wonder whether the relevant cross-checking procedures were in place in that scenario. HIQA has identified that 12 or 13 of the 19 units have not implemented the terms of the Drogheda report in full. I have been advised by people working in one of those units that they have implemented the recommendations fully, but that this has not been recorded because the staff in question were not consulted by management when the submission was being prepared. I wonder whether a cross-checking exercise was done. I raised this matter with the chief executive of HIQA when I met her this morning on her way to Dublin. This issue needs to be examined. I apologise for having to be excused in order to attend an Adjournment debate.

Regina Doherty (Meath East, Fine Gael)
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I thank the two representatives of HIQA for coming to this meeting. I wish Mr. McEnery the best of luck with this comprehensive plan. I disagree with Senator Crown in so far as I think it is a far-reaching plan. I hope it will go further in the years to come as HIQA's remit is developed. I would like to ask two questions about the plan. Do the plans for expansion that have been outlined depend on funding, recruitment and Government policy? If so, what level of engagement has HIQA had with the Minister and the Department and what was the outcome of that engagement?

The removal of funding from patient advocate organisations over the last year is a bugbear of mine. One of the first parts of HIQA's mission statement involves "putting people first". What is Mr. McEnery's view on how the patient experience in our hospitals is managed and monitored? There is no advocacy agency measuring the patient experience and feeding that information back to the Department of Health and the HSE. I am reminded of the old adage to the effect that if one does not monitor something, one certainly cannot manage it. What are Mr. McEnery's views in this respect? I do not mean to downgrade the efforts of individual hospital managers to provide for patient advocacy in their hospitals when I say that inconsistency is a feature of such initiatives across the country. In some cases, there is a complete lack of any engagement with patients. Does Mr. McEnery feel it might be within HIQA's remit to establish a patient advocacy arm, or at least to collect data on the patient experience that can be used as we try to ensure we are spending the health budget of €13 billion effectively?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I apologise for not being here to hear Mr. McEnery's presentation. I welcome him to this meeting. We have been missing each other, as Mr. Whelan will confirm. I am pleased to have this opportunity to welcome him and wish him every success in his new responsibilities. I believe HIQA has an important role to play. I would like to add a little codicil to that, as I have done previously. There is more than anecdotal evidence, regrettably, that HIQA's best efforts are sometimes misapplied subsequently by a system that is all too happy to use the evidence that has been accumulated for other ends.

Jerry Buttimer (Cork South Central, Fine Gael)
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I remind the Deputy that the subject of this meeting is the corporate plan.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I have reflected my deep concerns in that regard on previous occasions. I am offering my thoughts to Mr. McEnery now. I do not intend to go into the detail of the corporate plan. I have some concerns. I draw Mr. McEnery's attention to the recent closure of Rath na nÓg in Castleblayney, County Monaghan. It is well within his compass to know that the reasons given for the closure of that facility apply in other facilities that are not closed. The report was initiated after issues were raised by the highly trained and professional staff of the facility. It is most regrettable. It grates with me that this has happened to a centre that was tasked with caring for children from difficult circumstances. This problem is not confined to the child care area. There are other instances of it, for example, relating to the care of older people.

I will leave it at that. I wish HIQA every success. I wish Mr. McEnery well in his new responsibilities. I wish Mr. Marty Whelan, Ms Tracey Cooper and all the team the very best in what they undertake. I would like them to flex their muscles a little at some point. It is not good enough always to be used for the ulterior motives of others. The report process needs to be examined carefully. I refer particularly to the consequences of certain presentations. I will leave it at that. I thank the witnesses for listening to me.

Jerry Buttimer (Cork South Central, Fine Gael)
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I invite Mr. McEnery to reply to the questions that have been asked and the comments that have been made.

Mr. Brian McEnery:

If I do not cover all the questions that have been asked, I will be happy to come back in. I will begin by responding to Senator Crown's observations about the remit of HIQA. While I am relatively new to the position of chairman of the authority, I have seen the work of the authority on the ground since its initiation in 2007. I believe the work of HIQA has resulted in the quality of many people's lives being improved. I am thinking particularly of HIQA's work on the provision of care to older people, which is one of the most obvious reasons I was delighted to be asked to become the new chairperson of the authority. I know it makes a significant impact for older people.

We have just started to get involved in the area of disability services. I believe HIQA will have a significant impact on the improvements in services delivered to people with disabilities, as it has done in the cases of services delivered to older persons and services delivered in other areas.

Equally, I believe HIQA will have a significant impact on improving the services delivered to people with disabilities as it has for older persons and other areas. I believe that the provision of services, not just in terms of the physical environment, and the more important operational standards of delivering care has improved as a consequence of having a regulatory authority such as HIQA. My experience, even before I became a member of the board of HIQA, is that the role of the authority is paramount to improving care for older persons and persons with disabilities.

Deputy Mary Mitchell O'Connor asked if there are better services for older persons given that standards and regulation of that sector have been in place since 2009. I believe that is the case. I think that has been acknowledged by the providers and their representative body, Nursing Homes Ireland, which has welcomed the introduction of the standards. It acknowledges that the operational and physical environment has improved as a consequence. I believe that, both for the public and the private sector. The continuing application of those standards to operational matters on the ground but also the physical environment where there is a derogation in respect of those standards will continue to push improvements in those services. I absolutely believe that to be the case.

On the issue of preschool care and after-school care, that is not an area over which the authority has a remit. Our plan for 2013-2015 outlines a very significant mandate being given to the authority over and above our current role but preschool care is not one of those. As an authority we must be careful that we do not overextend our mandate and become ineffective in the roll-out of our services. Licensing of other areas is on our horizon but that aspect is not currently in the plans.

Deputy Seamus Healy asked about resources. Down the years I have reviewed very carefully HIQA inspection reports and have seen many references to inadequate staffing levels, this being an item of clinical risk which the authority would have raised, be it in nursing or care assistants. If the authority believes there is a risk to resident or patient safety as a consequence of inadequate or inappropriate staffing levels that will be highlighted in the inspection reports because it is a key aspect of care. More often it is not the physical environment that is the key determinant of the quality of care but the amount of staffing and the proficiency of the staffing who are in the care setting which is the important issue. HIQA does not avoid commenting on that issue where it believes the level is inappropriate.

Deputy Dan Neville has correctly outlined that an important issue is the level of resources which the authority has to enable it carry out is mandate. I am glad to say that at the start of the year the authority had 160 staff, now it has 180. Following full implementation of the monitoring role of disability services the number will grow to about 220 by the end of the first quarter of 2014.

Jerry Buttimer (Cork South Central, Fine Gael)
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Has the process of recruitment finished or is it ongoing?

Mr. Marty Whelan:

We started with 21 staff in the disability area yesterday. There are 24 other offers out which we would hope would be taken up in the next two to three months.

Jerry Buttimer (Cork South Central, Fine Gael)
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Go raibh maith agat.

Mr. Brian McEnery:

Inspection of the disabilities areas has commenced on the ground. The official date for commencement was 1 November 2013. The overall budget for HIQA in 2013 was just short of €18 million of which €12.7 million was the Vote amount and €5.2 million came from registration and licence fees. In 2014 the Vote amount is due to be cut to €12.3 million but the amount in terms of licence fees will grow to about €7 million, therefore, the projected amount of income for the authority is about €19 million for 2014, of which about 76% of our overall income is on payroll. I believe the resources are sufficient to enable the authority to carry out its functions. We expect 220 staff to be in situ by the end of the first quarter of 2014 which will allow us carry out the increased function in the disability area.

In regard to other areas for which we may be given responsibility, obviously this depends on Government, in terms of licensing and other matters. We will be interacting with the Department in due course as that is rolled out to outline the level of resources that will be required. I can assure the committee that as of now the resources are either in situ or about to be in situ to deliver our services for 2014.

Dan Neville (Limerick, Fine Gael)
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Who was responsible for inspecting the disabilities areas up to now?

Mr. Marty Whelan:

There were no inspections. The standards were launched earlier this year by the Minister of State, Deputy Kathleen Lynch, and the Minister, Deputy James Reilly. Before the end of October the regulations were signed by the Ministers and we commenced inspections, as the chairman, said on 1 November 2013.

Jerry Buttimer (Cork South Central, Fine Gael)
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I call Deputy Billy Kelleher. I am aware he had to attend another meeting.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Chairman and I apologise. I wish Mr. Brian McEnery the best of luck as chairman of HIQA. We are under pressure with the Dáil again. I wish to make a few observations-----

Jerry Buttimer (Cork South Central, Fine Gael)
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We are on the corporate plan as opposed to-----

Billy Kelleher (Cork North Central, Fianna Fail)
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-----on the corporate plan. First and foremost, in the whole area of the reconfiguration of hospitals which is now part and parcel of the roll-out of the Government's strategy to move towards universal health insurance with the establishment of hospital groups, hospital trusts and what flows from them, there is a concern, that certainly those in opposition would hold but also in communities throughout the country, that sometimes HIQA reports can be used in a way to close down facilities. I do not mean that in the context of Roscommon, we all know about that, but in terms of ensuring that where there are deficiencies in services they are highlighted at the start of a programme rather than at the end when it becomes almost arbitrary that they are closed. I believe HIQA has a role to play in highlighting deficiencies and making recommendations and allowing time for those recommendations to be implemented. I am concerned that, as stated in the HIQA plan, fiscal constraints are causing difficulties for key stakeholders. The State is also a key stakeholder and it also has fiscal constraints imposed on it. When HIQA inspects a facility and finds deficiencies in the area of patient safety it makes a report. As that does not give stakeholders an opportunity to address those particular issues it is a matter that will have to be looked at both from the point of view of HIQA but equally from the point of view of hospital groups themselves.

That leads to another key issue. We have a shortage of hospital consultants and posts that cannot be filled for various reasons.

We can argue as to why that is the case and as to why consultants are not taking up the post, but the bottom line is we have a scarcity of consultants in the country. This has a negative impact on patient safety and the quality of care patients receive in our hospitals. Does HIQA have a role in highlighting for the Government, the Department or the HSE that there comes a stage where the shortage of personnel causes difficulty for the provision of care in a safe environment? For example, recently four CEOs clearly stated that they had concerns about patient safety in their hospitals in the Dublin area. We could discuss why their letters went public and why we had an issue over payments, but those issues are for another day.

Jerry Buttimer (Cork South Central, Fine Gael)
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We are here to discuss the corporate plan and we are staying on that.

Billy Kelleher (Cork North Central, Fianna Fail)
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I am not, because the overriding issue for HIQA is patient safety. We have a situation where CEOs of a hospital have expressed concern, but does that ring alarm bells for HIQA or does it just say that is normal politics in the play for resources? Does HIQA go in and examine whether there is a serious issue? As a spokesperson on health, I believe we now have a situation where consultants are working under huge stress. I am no friend of consultants, nor am I their enemy. I am not saying this because Senator Crown is here next to me. All of the front-line medical staff in our hospitals, particularly the acute hospitals, are under huge stress and duress. Has HIQA a role to play in that regard?

In regard to social services for adults and children in the disability area, I am aware this is a new area for HIQA and that it has published guidelines on it. However, we need to understand that many of the facilities in place are home for these people. HIQA must be very conscious of this when it conducts inspections. This is true not just in the area of disability, but also in regard to visiting homes for the elderly. I know the overriding consideration must be the safety and quality of care, but HIQA must be mindful that some of these places are home for these people and are the only places they know and are comfortable with. Immediate upheaval because of some problem or other can have a profound impact on these vulnerable people.

I do not expect a response to my points because I must go to the Dáil to deal with a Bill on health. I wish the new chairman of HIQA well and thank HIQA for its willingness to provide information to the committee regularly.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank HIQA for its presentation and wish Mr. McEnery every success in his new role. I know he will focus on the job. Since we first met with HIQA representatives in this committee, including Ms Tracey Cooper and Mr. Marty Whelan, I have found them honest and open. This has led the current position and status of HIQA. I believe it is important we recognise HIQA as the eyes and ears of our communities and of people whose loved ones are in hospitals or who need care.

My advice to the new chairman is not to get lost in the job or to spend his time behind the desk. He must be the eyes and ears of the community. We do not want another HSE or organisation that is top heavy with management or where the service is not provided at ground level. I heard a debate the other day in which it was argued that people who become members of parliament should have a degree. My opinion on that is there is nothing better than common sense and the ability to deal well with people. That is what HIQA should be about. It should be about having the common touch and being able to identify with people.

In the past few months, HIQA has proved it can do this and where it has seen faults in the services, it has tried to bring about a change. Unfortunately for some people, this has meant some places have had to close. My main advice to HIQA is that its staff should not be brought in to sit behind a desk, but to go out to do the job they are being paid to do. We do not need more people sitting behind desks. As politicians the golden rule for us is that while this is the job in here, the bigger job is outside. If we do not communicate with the people we represent, we do not get re-elected.

Mr. Brian McEnery:

I will begin by addressing the issue raised by Deputies Ó Caoláin and Kelleher in regard to HIQA reports being used for other purposes. HIQA is an independent authority and its focus is on the safety of patients and residents in nursing homes. This is its agenda and the authority's focus will be to continue to apply a risk-based approach to our health services. We have no agenda other than that. This has been our mandate since our commencement and will remain the case for both the executive and non-executive boards which oversee our operations.

Deputy Doherty mentioned managing and getting feedback on patient experience. This is a significant part of our work and the HIQA inspection service seeks resident feedback and the feedback of the families of residents. This will be part of the inspection process of any of the additional services HIQA is mandated to inspect. I reassure the committee that we conduct our inspections and make decisions from a practical perspective. We do not just inspect the physical environment, but try to get an understanding of the experience of residents and patients and this will continue to be the case.

Deputy Ó Caoláin mentioned Rath na nÓg. HIQA has investigated the issue in this regard appropriately. This is an area on which HIQA, applying its risk-based approach, will continue to focus. Deputy Kelleher alluded to the shortage of consultants. Deputy Healy commented on resources in facilities and where we believe shortages cause clinical risk, we will allude to that when producing our inspection report. Currently, we do not have a mandate to inspect hospital resources. Our mandate for hospitals only relates to infection risk in hospital services.

I concur with Deputy Byrne in regard to the role of HIQA and the need to be out on the ground. I believe the authority operates in a cost effective manner. The expenditure on the authority is 0.1% of the health care budget and it is intended that we maintain a nimble, cost effective authority that is not overburdened with management at staff level.

It will be very focused on ensuring that what Deputy Kelleher said about safety and quality of care will be the case. There are 1,300 centres for disabilities, many of them with just two or three residents in them, and we will be very conscious of the fact that these are people's homes. They are destined to remain in them for quite a period of time, and we will treat them accordingly, while ensuring that they are in a safe and appropriate environment for care.

Jillian van Turnhout (Independent)
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I do not want to stray from the corporate plan, which I fully endorse, but Rath na nÓg was raised. I understand that a staff member alerted HIQA, which investigated Rath na nÓg and------

Jerry Buttimer (Cork South Central, Fine Gael)
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I would rather not deal with specific cases.

Jillian van Turnhout (Independent)
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My concern is with the chilling effect of the way HIQA reports are then used. If HIQA comes in, we now have a serious crisis on special care placements and then a waiting list, which goes against practice.

Jerry Buttimer (Cork South Central, Fine Gael)
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We will have a further discussion next year with the chief executive of HIQA, Ms Tracey Cooper, on operational matters rather than on the corporate plan, as well as with Mr. McEnery as chairman. The Senator's point is well made.

I would like to thank Mr. McEnery and Mr. Whelan for coming in here today. It is important that we recognise the role of HIQA. We do not all agree with Senator Crown's comment that it is the armed wing of the HSE. It does play an important role in improving the outcomes for people who use our health services and our social care services. I wish Mr. McEnery every success in his tenure as chairman. I sincerely thank the staff of HIQA, in particular Mr. Marty Whelan, head of communications and Ms Tracey Cooper, chief executive. I wish them both well and I thank Mr. Whelan for continuing to disseminate information to us at all hours of the day and night.

I would like to remind committee members that we are meeting next Thursday morning with the health insurers, and we will have a small section in private session to deal with our work programme and our minutes and correspondence.