Mr. John Saunders:

The Deputy is correct in saying that there were 68 admissions of children to adult units in 2017. To put that in context, in 2012 there were 107 such admissions, in 2013 there were 98, in 2014 there were 92, in 2015 there were 96 and there were 68 such admissions in 2016. There has, therefore, been a shift. One of the roles performed by the commission is to carry out inspections. It sees what it sees, makes very clear statements as to whether what it sees is appropriate and makes recommendations for change. There is a dialogue with the service provider around that and, as I said earlier, in many cases small changes occur as a result of that dialogue. However, if that dialogue is not sufficient to bring about changes, the commission can impose conditions and timelines within which such conditions must be met. Compliance is monitored by the commission through the inspectorate. Inspections would take place on a monthly or three-monthly basis to ensure that the required changes take place. Again, if one looks through the thousands of pages of our reports, one will see changes brought about by that process.

We have the power to impose much more severe restrictions such as closure. However, one of the issues in mental healthcare, as everyone knows, is that the vast majority of services are provided by the statutory provider, that is, the HSE. If one of those services is closed, one is faced with the problem of where the people using that service will go and who will provide an alternative service to them. In many cases, there is no plan B because the statutory system is providing the services. We need to be very careful about using more draconian measures.

Having spoken to the inspectorate, I can say that people working on the ground often welcome the commentary of the inspectorate and the commission because it provides very clear direction to them in terms of the changes they can make to improve the services. When one talks to people across the system, many of them will say that bringing about change is a very co-operative process. It is not just about saying a service must close or do X or Y. It is about pointing out the changes that are needed and bringing people up to that change over time. When one looks at the position historically, one can see that improvements have taken place. The factors which mitigate against that are often down to the fact that people do not have the necessary resources or are working in buildings that are not fit for purpose. Often the issues are not localised but are national and, as such, they require a national response.