Mr. Mervyn Taylor:

There are gradations. One of the issues, particularly in private nursing homes, is that some of them claim they have their own advocate. In other words, they tell us we will have a person that they will appoint to represent our interests, and if our interests are against their interests then their interests will win out. This is a piece of nonsense. We also have the argument being used that because there is no formal recognition of independent advocacy they do not have to let us across the door. I am not an lawyer, but my understanding is judges quite regularly in court refer to the fact that people should go to mediation and not be in front of the court. To the best of my knowledge, mediation is almost there but not yet, but judges have been talking about this for years.

The big issue is family pressures, and this can be particularly because families are divided and they do not want another person coming in. We can understand this to a certain extent, but they are still ignoring the right of the person to his or her own voice. Sometimes it is because the family is actually actively exploiting that person. There might have been a daughter or son living in that person's home when that person was shoehorned into the nursing home and in fact that son or daughter is getting a place free of rent that would otherwise be €1,800 month. That family then puts pressure on the owners of a nursing home, and we know of some situations like this, who then say they will lose income if they annoy this family, so there is a real problem there. Sometimes it is also just stubbornness, and it will take some time to break this down. HIQA is starting to ask during its inspections whether there is an independent advocate, whether there is access to one and whether the nursing home can show proof of this. There are still some people, and I can put it bluntly, whose attitude is they own the building therefore they own the residents. I am putting it baldly, but this is what it boils down to.

In relation to the question on whether private nursing homes welcome us, the fact of the matter is there is another side to this. A total of 46% of our complex cases last year involved nursing homes, many of which were private nursing homes. We have a principle that we collaborate first and then we challenge, but many private nursing homes are coming to Sage because they are not getting the supports they need for some of these very challenging situations from their industry organisations. We are effectively a sounding board for them. It is a tale of two cities. There are those who will bar us and there are those who will actively be on the phone to us asking us for God's sake to help in a particular situation, which we do willingly. I am just saying there are two different types of nursing homes.

I must say that although we experienced a few rather frosty handshakes in the early stages of our establishment a few years ago in 2014, our right to be in a HSE facility has never ever been challenged, because an ethos is developing and a network of understanding is developing in the public sector. It is different in the private sector. Many of the providers are quite isolated and they are not part of any grouping, or where they are part of a grouping the corporate policy is to be suspicious of us and not to let us in.

With regard to Deputy Durkan's question on advocacy officers in each institution, I do not think it relates to my previous answer as we cannot have an institution providing its own advocacy officer. We can have an advocacy person who champions and pushes the idea, and in each of these facilities there is a designated person, and, if I may, I will ask my colleague Ms O'Callaghan to briefly speak about this.