Ms Mary Dunnion:

I thank Deputy Murphy O'Mahony and Senator Colm Burke. I will cover some of the points raised and will share answers with my colleague, Mr. Finbarr Colfer.

I shall begin on the policy of decongregation. I totally accept that families can be very concerned about it. I also accept that, in the context of inspecting centres, that these facilities have been home to the people involved for 20, 30 or 40 years.

On the other side, however, we have seen the huge benefits of people transitioning into community services and residents there have told us how much better those services are for them. We support the national policy of transferring people from congregated settings to community settings but we think there is now an opportunity. While decongregation is happening, and it is very positive, it has had some unintended consequences. For example, an elderly person may not be suited to a move to a community. It just might not be the right setting for them. In addition, as Mr. Quinn said, some of these services are unregulated, which is a concern to residents. In this context, we have prepared the discussion paper, which poses the question as to whether the type of model of regulation is the right one for the future. We firmly believe that the policy of regulation should be aligned to social and health care policy, which is not how it is currently structured in the Health Act. To answer Deputy Murphy O'Mahony's question, we believe decongregation is a positive. However, we feel it has some unintended consequences, particularly for very vulnerable people. We propose in our paper that a different model needs to be considered, which looks at different service types for people such as day care services, ambulatory care and residential services. Furthermore, some people in disability services may require nursing home services. There are many different models that need to be considered and now is the time to do so. The policy of decongregation has probably highlighted these issues.

The issue of Garda vetting took us by surprise when we made discoveries in that regard because it was beyond our understanding as to why one would employ someone who did not have Garda vetting. As the committee will be aware, provisions in this regard were enacted in legislation in April 2016. It is not possible for me to quantify the numbers because we found areas on inspection where Garda vetting had not been done. I can happily report now that there has been a sea change in this regard. This happened in 2016 but it is seen in 2017 that people are now making sure that Garda vetting is in place. I assure the committee that when we come across instances of Garda vetting not being in place, we ensure that the staff member is not on the roster to look after vulnerable people until the Garda vetting is in place.

The chief executive officer has talked about the accountability framework. This is very important in the context of services and our job in HIQA is to work to see the quality and safety of services are there. We are only one player in this regard; the chief groups responsible are those that deliver the services. However, I believe as regulators we have a very important part to play in the quality and safety of services. One of the aspects we have seen - we mention it in our paper and have brought it to the attention of other committees - is that where someone purchases a service, be it the HSE or any other body, there should be an arrangement in the contract which ensures that the service being delivered is of a high quality and there should be checks and balances to make sure that is happening. I strongly feel that if those arrangements were in place, we would not be finding some of the issues we are now finding because they are not being monitored. Therefore, we very much welcome the early work the HSE has begun on commissioning, which I see as accountability. I know "commissioning" is sometimes not the greatest descriptor but it is accountability. We in HIQA are very pleased to become involved in that, particularly in service delivery, where public funds are being paid for the care of very vulnerable people.

I will hand over to my colleague to discuss respite care and day care services.