Ms Carol Grogan:

I thank the committee for the invitation to discuss the topic of rights-based care for children with disabilities and to consider the integration of primary care, disability and mental health services and rights-based care. As the Cathaoirleach said, I am joined by my colleague, Finbarr Colfer, who is deputy chief inspector with responsibility for services for people with disabilities.

As HIQA's chief inspector, I am responsible for the regulation of designated centres for people with disabilities that provide residential services. In inspecting and reporting on the standard of services, we also place a strong importance on meeting people who use the service, including children and adults with a disability. Hearing from people who use services and understanding their lived experiences are both essential in determining how their rights are respected and ensuring that they are supported to live a fulfilling life. Our inspectors spend significant time meeting residents on inspection and use the information they give to inform our inspection findings. In our experience, this engagement supports quality improvement in designated centres. In addition, we receive, analyse and risk-assess information from a range of sources to inform our responsive approach to regulation. This enables me as the chief inspector to respond proactively to regulatory risk and to prioritise our regulatory activities.

It is important that all children, including children with a disability, receive appropriate, safe and good quality care. HIQA, alongside our colleagues in the Mental Health Commission, has developed overarching standards for the care and support of children using health and social care services. Together with the current regulatory framework, these standards, when approved, will support providers to ensure that children in receipt of services can continue to achieve the best possible outcomes.

Last month, we published an overview report of the inspection and regulation of designated centres for people with disabilities in 2022. Designated centres can be registered as centres for adults, as centre for children or as centres for adults and children which are also known as mixed centres. Mixed children and adult centres are mostly respite centres where there are separate respite breaks for children and for adults and they are not accommodated together. They can also be for where children are transitioning to adulthood, and the provider is facilitating children and adults to continue living together.

At the end of 2022, there were 1,342 centres for adults with disabilities, with 8,405 registered places. There were 36 mixed centres for both adults and children, with 215 registered places. There were also 100 centres for children only, with 410 residential places. This is an increase from 2019 when there were 80 children centres with 347 registered places.

In 2022, HIQA carried out 1,329 inspections of designated centres for people with disabilities. Our inspections found that the majority of centres provided a good standard of care and support to people with disabilities. However, the report also outlined concerns about poor findings in relation to governance and management in a number of settings. Our findings consistently demonstrate that good governance and oversight arrangements in centres results in better standards and outcomes for residents with regard to promoting their rights.

Another key learning for us during 2022 was that while we have seen an improvement in compliance levels in congregated settings, which is to be welcomed, non-compliance in these settings continues to be higher than in community-based settings in key areas that impact on the rights of people with disabilities. This means that residents living in community settings have better access to quality care and support, and experience a better life as part of their communities.

As an organisation, we continue to enhance our human rights-based approach to regulation. In 2022, all of our inspectorate staff received human rights training. This year, we are focusing on promoting improvements for residents by focusing on their rights. We have initiated a new programme of thematic inspections of restrictive practices, which are the intentional restriction of a person's voluntary movement or behaviour. The inspection programme focuses on assessing physical and environmental restraints as well as other forms of restrictive practices to ensure people with disabilities are supported to live a life of their choice.

Our inspectors are also actively identifying centres where human rights training has been provided and speak with residents and staff to identify examples of good practice that have been introduced as a result of the training. Our inspection reports in 2023 will reflect these observations, and we intend to share the overall learning from this initiative with the wider sector through our overview report for 2023.

I assure the committee of HIQA's continued commitment to promoting and protecting the rights of people with disabilities to live in a safe environment. HIQA is focused on how we can use our legislative powers to support a human rights-based approach to service provision. We want to support providers to move beyond compliance, to use the regulations and national standards to pursue ongoing quality improvement in centres for people with disabilities. I thank committee members for their time and attention this evening. We look forward to answering any questions they may have.