Mr. Pat Healy:

I thank the committee for the invitation to attend this morning to discuss the subject of adult safeguarding.

I am joined today by my colleagues, Michael Fitzgerald, head of operations and service improvement in services for older people, and Tim Hanly, general manager in the national safeguarding office.

Abuse of vulnerable persons is, unfortunately, a disturbing reality. However, there is now greater public awareness about the existence of abuse of older persons and people with disabilities within society. Indeed there is now a strong expectation on legislators, policymakers and service providers to take adequate measures to combat abuse. The impact of well-publicised reports and regulatory inspection findings into failings to protect the welfare and safety of service users in recent years has led to significant changes in policy and practice as well as models of service provision within the health and social services sector to address this most significant issue.

For the HSE's part, an elder abuse policy and social work led support service has been in place since 2007. Following consultation in recognition of the need to widen and improve this policy, the HSE on establishing the social care division in mid-2013, launched its policy, Safeguarding Vulnerable Persons at Risk of Abuse: National Policy and Procedures, in December 2014. The policy declares that all service providers to disabled and older persons must have a publicly declared no-tolerance approach to any form of abuse. All service provision must promote a culture which supports this ethos.

Since the launch of the HSE's safeguarding policy, a number of supporting structures have also been put in place, including the establishment of the National Safeguarding Office, which provides leadership, oversight and co-ordination for all aspects of the policy and practice in safeguarding vulnerable adults. In implementing the policy, the HSE has set up nine safeguarding and protection teams, one in each community health organisation, CHO, to co-ordinate consistent responses to concerns of abuse and neglect. These teams are managed and led by principal social workers and staffed by social work team leaders and professionally qualified social workers. They provide oversight and support to all service providers, including those funded by the HSE. Each CHO has also established a safeguarding and protection committee, chaired by the heads of social care, which supports the development of a culture that promotes the welfare of vulnerable adults and provides support and advice to the safeguarding teams and senior management. In 2016 alone, almost 8,000 notifications of safeguarding concerns were submitted to the safeguarding teams.

The HSE has invested in additional staffing and support resources to strengthen the capacity base of these teams for oversight and management of safeguarding concerns. Over the past three years approximately €2.3 million has been invested in the recruitment of an additional 34 social worker positions and ten administrative support workers into the safeguarding and protection teams. Almost 60 staff members are involved in the safeguarding teams throughout the country. However, the implementation of the policy also saw the appointment of more than 900 designated officers in service settings relating to disability and older persons, who in their own right as senior managers are the key people to receive concerns or referrals of abuse, carry out preliminary screenings and develop safeguarding plans where appropriate. The nine safeguarding teams support the designated officers in their day-to-day work to ensure a consistent approach to the implementation of the policy across these settings.

A strategic training programme continues to be rolled out and the HSE has achieved a critical mass of more than 30,000 staff in the HSE and funded agencies who have been trained to date. The HSE's implementation plan for the adult safeguarding policy is part of a wider programme of reform and quality improvement measures across the social care sector. Significant change management programmes are being implemented in areas such as decongregation within residential care and new directions for day service users which have clear implications for advancing the safeguarding agenda. These developments have been clearly underpinned by person-centred principles and a clear message of no tolerance of abuse.

At national level, the HSE established the national safeguarding committee, which is a multi-agency and intersectoral body. This committee, which works collaboratively with a wide range of stakeholders, recognises that safeguarding vulnerable adults from abuse is a matter that cannot be addressed by any one agency working in isolation and cannot be solely seen as a health or social services responsibility. Representatives from the national safeguarding committee are also present today to address this committee which is most welcome.

As envisaged at its commencement, the HSE is undertaking a review of the safeguarding policy. This review has already highlighted many improvements since the introduction of the safeguarding policy, especially in areas such as awareness training, improved systems for recognising and reporting abuse, and challenging inappropriate attitudes and behaviours. The review has also highlighted areas that need improvement and areas of practice that need strengthening. While the improvements I have outlined will continue, there remains a significant underlying challenge for the HSE and other bodies in responding effectively to safeguarding issues due to the gap in legislation. There is a clear deficiency in the lack of a legislative framework for assessment, planning and co-ordination in responding to safeguarding concerns and managing interventions.

The HSE cannot undertake and co-ordinate adult safeguarding and protection in isolation. In this regard, the HSE recognises that the current safeguarding policy has clear constraints in its capacity and scope. The policy is limited as it is a health service led policy, and while co-ordination has been improved with the establishment of the interagency national safeguarding committee and through the development of interagency protocols, legislation is needed on an interagency and societal level to effect the necessary changes. An important task for the drafting of any such legislation will be to develop a clear and easy to understand definition of who needs protection across all services and whether the vulnerable person concept should be replaced by a definition of an adult at risk.

Any such legislation providing powers of intervention in the lives of vulnerable adults should give due regard to the person's capacity to keep themselves safe and to the appropriate application of consent. The framing of the legislation needs to be careful to balance human rights principles in areas such as autonomy with the need for protective measures. Any law should be proportionate in its application and scope and needs to include essential safeguards on a person's right to express his or her will and preference on how he or she lives his or her life. A key consideration for future legislation will be the appropriate obligation on relevant organisations to report suspected abuse or harm to the appropriate authority. International research has indicated differing impact and outcomes with regard to permissive or mandatory reporting. Further analysis and research will be needed to consider the appropriate legal framework for such requirements.

International research and evidence has consistently highlighted the importance of a process and structure for mandated interagency collaboration and co-ordination on adult safeguarding. This will be of particular benefit with regard to information sharing for assessment and protection planning which will need to be incorporated into future legislation. This is of particular relevance for all services involved with adult protection but especially core State authorities such as the health services and An Garda Síochána, and it should also strengthen arrangements with Tusla regarding children progressing from State care into adult services and where vulnerability exists. This mandated interagency collaboration should also include the requirement to put safeguarding committees on a legislative framework to mandate co-ordination and collaboration among services with key safeguarding roles as well as ensuring appropriate reviews are undertaken following critical incidents. Legislation in this area will also need to strengthen vulnerable adults' right of access to independent advocacy which is most relevant when they are subject to a safeguarding report or assessment.

As a health service provider and commissioner of services we recognise that there is still a long journey of improvement and reform to travel and we acknowledge our shared responsibility to advance the safeguarding agenda. While much progress on adult safeguarding in the State has been made over recent years, we clearly need a statutory framework for adult safeguarding to address the issues and deficits I have highlighted.

This concludes my opening statement and, together with my colleagues, we will endeavour to answer any questions members may have.