Mr. Phelim Quinn:

I agree that there are a number of critical issues here. I would go back to some of the points that Ms Dunnion made on the scope and limitation of HIQA's role in respect of section 8 of the Act to monitor against nationally-mandated standards. We have demonstrated both through our investigative work and our review work that, in fact, we can highlight issues not only of clinical governance but in fact issues relating to the governance and leadership of the health and social care services. There is a very specific theme within the national standards that deals with leadership and governance and that has been highlighted. It was critically highlighted, for example, through the investigation by and publication of the Portlaoise report where we highlighted deficits in governance and leadership at various levels within the structure.

Ms Dunnion spoke earlier about how binding or enforceable are the recommendations. That is a matter for policy makers and, in the absence of a commissioner of care, somebody needs to hold the HSE to account for the implementation of any recommendations we make. Ms Dunnion made a point about commissioning as a parallel process to the regulation of health and social care and I genuinely believe this is becoming an increasingly obvious deficit. In the main, a regulator can only make its assessment and recommendations. It is not normally the case in other jurisdictions that the regulator manages the performance or implementation of recommendations. In other jurisdictions, we see the commissioner stepping in to ensure the quality and safety of those services. Critically, it is not just about what HIQA does or comments upon with regard to clinicians and care providers within services. We have highlighted, and will continue to highlight, the issues at leadership and governance levels, be they at local hospital or hospital group level, and at national level.