Mr. Phelim Quinn:

I will take the issue of the regulation of home care in the first instance that the Deputy spoke about. That also relates to our articulation of what is happening around moving people out of traditional congregated settings into more community integrated types of services. In some instances, we have seen people move from those large congregated settings into smaller community-based settings that fall into the definition of a designated centre and therefore remain regulated. However, in other instances we have found that the models of care that are starting to emerge can involve things like supported housing, in which case the person becomes a tenant within a particular service. In that case, the care and support services are provided by a provider, but they do not fall in under the definition of a designated centre because it is home care that is being provided.

Our concern is that, at the minute and since November 2013, we have a regulatory framework that affords protection to the people in receipt of residential care services. We are worried that if people move out of residential care services into home care services, they might be not be afforded the same protections. In exactly the same way, people who have not been in residential care are in some instances extremely vulnerable in their own homes while in receipt of care from service providers that are providing home care. I am not saying that as a blanket negative comment on home care provision. Like any other service, the vast majority of service providers are well motivated. However, people are particularly vulnerable in receipt of care in their own home on a one-to-one basis. It is on that basis that we have been asking for the introduction of home care regulation as a policy priority. Looking at other jurisdictions, we see that home care regulation has been established since well into the early 2000s because of the recognition of the specific vulnerabilities of people. That includes conventional home care, which is people in what is termed their own home, or people in individual or group living settings who are tenants within that setting and require the receipt of care and support services. For that reason, we have expressed concern.

Deputy O'Connell also asked about licensing and HIQA's role in, for example, the acute health care setting. Ms Dunnion might be able to expand on this. What I wish to highlight from today's perspective is that we are talking about the health information and patient safety Bill and what will be contained within it. We have concerns because it is not licensing and it is really an extension of our current role and remit within publicly provided services. Our concern is that while it will provide some level of oversight within those services, the powers that we have are relatively limited. Under a licensing regime, I believe the powers can be much more clearly defined and, as a result of that form of regulatory model, we may effect greater improvements within services.

With regard to our application of standards and regulations, I repeat that regulations are developed by Government or by the Department. We apply ourselves accordingly. Yes, we develop standards within HIQA, but those standards are developed by HIQA for Government to mandate and prescribe to services. We do not change those services ad lib. They become the established framework for improvement and are disseminated into the sector. The sector is allowed some time to those standards. Another critical issue within a licensing regime is what we call a statement of purpose. A hospital clearly sets out what it proposes to provide and how it proposes to provide it safely. It is against that statement of purpose that we regulate the service. Ms Dunnion might wish to expand on that.