Ms Mary Dunnion:

I concur with Mr. Quinn that it would be a tragic unintended consequence if people felt they could not look after their relatives at home but it is important that people are cared for safely.

If the regulation of home care was introduced the first step would be, not dissimilar to older persons with a disability, that someone must register himself or herself as a provider of home care. Therefore, it already corrals the group that one considers in that context. This aspect reinforces the importance of integrated care because integrated care combines the regulated bit and the integrated care associated with a person's journey from birth to death. There are more controls than just what the regulator does in the context of home care and we must be cognisant of same.

A question was asked about regulating outdated facilities, which was particularly pertinent to the acute sector. From the point of view of regulation, the Health Act makes two differentials. We regulate designated centres for older persons and disability and in that the provider must register and pay a fee. There are enforcement powers and the provider must comply with regulations that have been set by the Department.

There are no enforcement powers in terms of health care and child protection and welfare. HIQA has a monitoring role. HIQA has conducted 156 inspections of acute health care facilities over the past number of years. While we have seen pockets of excellence we have also seen a deterioration in the infrastructure within the hospitals and the acute sector. The reports that we have published have put a focus on them. In the areas that we consider, we would have particularly identified inadequate theatre facilities and an inadequate basic maintenance of many hospital facilities. It is the maintenance budget that is often cut when things get tough. The move immediately opens the door to infections, poor cleanliness, hospital acquired infections and it is a continuum. Yes, we have seen facilities that are outdated and require investment. We have also seen the need, and this is why the committee is so welcome, for a policy direction for acute services and for a definition of the delivery of services pertinent to the type of hospital that can deliver that type of services safely for people using them.

Do we differentiate between public and private providers? No, we do not.

In the older persons and disability services, both public and private are under the same regulations. It would be impossible for us to do that and we would not have a desire to do so. There is no differentiation between them. They have to be compliant with the same regulations. We inspect in the same way. We meet residents living in all of these services and we have a standard approach to how we elicit from them what it is like to live in the nursing home or disability centre. We publish all our findings and there would be no inconsistency, whether it be a public or private facility.

As for whether we have looked at the cost, we have not. What we have done to date is look at regulation in other jurisdictions. While we have built a knowledge of regulation in Ireland, to inform and enhance that knowledge, and hopefully, to inform policy, we have looked at what regulation does in other jurisdictions, particularly in the context of older persons and disability service and then in the context of licensing of acute health services. We have not looked at the cost benefit of any of those models because it would not be within our remit, or in our resources at present, to be able to do that.