Ms Mary Dunnion:

As Mr. Quinn has outlined, one can draw a line down the 2007 Health Act. One can consider it in the context of registry services, which is disability and older persons, and with that there is a registration cycle and enforcement powers. There are regulations that are defined as what a service must have in place. HIQA does not develop the regulations because they are developed by the Department of Health. That is designated centres.

In terms of the public health service, we are talking about the acute general hospitals. HIQA has no powers in that context bar the power to monitor and report. What determines what we monitor are the national standards for safety and better health care. While HIQA develops those standards they are handed to Government and mandated by the Minister as the direction of travel for the health service.

If we begin to take a look at the Health Information and Patient Safety Bill in the context of the private health service, as we are currently legislated to, what we would do and all that we could do, and the latter is the important bit, is continue the programme similar to the public service. The resource requirement to continue to do that equates to eight wholetime equivalents. The important piece here is that we do not regulate the health service. We regulate the social services at present. As Mr. Quinn outlined in his introductory paper, we conduct quality initiatives across the acute service.

The Health Act also gives us the power to investigate. We can investigate at the behest of the Minister or the board of HIQA and at that time we will make recommendations. Again, HIQA has no role in monitoring or ensuring that those recommendations are implemented.

That is the differential. The HIPS Bill will allow us to go into private health care but we will only be able to do what we currently do.

In the context of the licensing Bill, HIQA is working in a multi-sectoral committee which is led by the Department of Health and has private health care representation and HSE representation also. In its preparations in the context of the development of that legislation and, hopefully, to influence its design, HIQA conducted an international review of what happens in health care across all jurisdictions. In essence, all health care has some from of regulation. That may be called "licensing". It can have different names but it is much the same type of thing. Where it becomes different from Ireland is that it does not have a registration cycle. Currently, we register an older person's home or a disability centre on a three-year cycle albeit it was extended in respect of disability to five years. This cyclical approach does not happen in acute health care. There would be enforcement powers in the context of the licensing of health care but whether those powers should be similar to what is involved in the regulation of social services is a subject that must be examined carefully. By way of example, it would be untenable to suggest that one would close a hospital.

We will be looking at the potential licensing of services, which we would very much advocate. A key thing members should consider is that many licensing agencies internationally have a commissioning service for health care. That means the national provider will commission a hospital to provide orthopaedic surgery for example. However, when the provider engages with the hospital, it addresses security around the quality and safety of services. Currently, that system does not exist in Ireland. What would enhance any licensing regime but more importantly the quality and safety of services would be if something like that was aligned to the licensing model in Hackney. In that context, it is impossible for us to describe at this moment in time the resources that would be required for that. We are actively working with our colleagues on what should be included in a licensing Bill. We have drafted an expansive paper looking at other regulators and we have considered what it would look like if we were to apply the enforcement regime in designated centres across the Irish health service. It is an interesting exercise to conduct because the feasibility of doing it is daunting.