Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

The impact of austerity policies on people with disabilities and their families has been devastating. I know the Minister of State knows that to be the case. The mobility allowance scheme was closed and educational supports, including resource teachers and special needs assistants, diminished. Medical cards have been targeted and the mainstream public services upon which those with disabilities disproportionately depend have been decimated. People with disabilities remain more than twice as likely to be unemployed compared with the typical population and just 15% of people with an intellectual disability are in employment. Sinn Féin has a vision for society in which all citizens, including those with disabilities, can play a full and independent role in all aspects of life, relying as far as possible on mainstream services for health, education and employment but with the support of tailored disability services where necessary.

The Health Act 2007 provided for the establishment of the Health Information and Quality Authority, known popularly as HIQA. It provided for inspection and regulation of designated centres and the framework for registration of these designated centres. The introduction and establishment of such a body as HIQA was very positive. The measures in the Health (Amendment) Bill 2016 relate exclusively to residential centres for people with disabilities. I understand there are 1,000 residential centres for people with disabilities throughout the country and by June 2016, some 556 had been registered. HIQA estimates that over 350 centres will not be registered by the end of October this year.

We in Sinn Féin will vote in favour of the Health (Amendment) Bill 2016. We would of course have wished for all centres to have been registered by 31 October 2016, although we understand some of the complexities associated with such a process and we will therefore support the extension of time request. However, we have a number of concerns that we would like the Minister of State to address. I ask him to note these questions. We appreciate the major administrative task involved in the process but are other specific factors leading to such a delay? In 2015, HIQA reported to the Department of Health that it would not be possible to complete all registrations by the prospective timeline. Is it a question of resources? If so, why were more resources not directed to HIQA to allow it to complete the work within the initial agreed timeframe?

Following consultation with Inclusion Ireland, a body with which the Minister of State is well familiar, it has come to my attention that there is a list drawn up by the HSE of centres that it has already accepted will never meet the criteria required for registration. I ask the Minister of State to note this important fact. Will he comment on this? Given some of the controversies and scandals uncovered by the media and HIQA in recent times and not exclusively in disability residential settings, but across the social care sector, we have deep concerns that more than 400 residential settings have never been inspected.

We are aware that HIQA has returned to facilities that received unfavourable and damning reports many times, yet this large number of facilities remain uninspected, with the potential for service users to be at unrecorded and increased risk.

As recently as last week it was reported that three residential centres for people with autism have now been taken over by the HSE at the direction of HIQA due to serious non-compliance. It is extremely concerning to learn of the significant failings found by HIQA relating to the care and welfare of 47 adult residents with autism living in three farm-based centres. These centres were inspected on a number of occasions over the past 18 months and particular concerns were raised regarding inadequate measures to ensure residents were protected from assault, ongoing risks to residents that were not being appropriately managed or responded to, poor governance and oversight leading to negative outcomes for residents, and poor management of staffing resources and inadequate staff training. Adults with special needs and their families require and deserve the highest standard of care. To hear of such non-compliance is extremely distressing. I am anxious that the extension of two years provided for in this Bill may mean that many other centres will continue to operate without being inspected for a considerable period, potentially leaving vulnerable people in facilities that are simply not at the standard required.

In the context of this Bill, we are of the strong belief that there is a great need to move the focus from congregated settings to the community, and not just to smaller settings but to full integration. Congregated settings are facilities where residents live in close proximity to each other and with an institutional mindset. They are inappropriate homes for anyone, particularly those with complex needs. The focus needs to shift from centre-based services to supported mainstream integration. The focus may be on empowering service users to take as full a role in life as possible. Resources are also needed to support families. This process of decongregation is happening but at a very slow pace. It must be accelerated and funding redistributed so that the main focus is on community rather than specialised settings.

I would welcome a response from the Minister of State to some of the points I have raised. In particular, I lay emphasis on the question of whether there is a HSE list of centres or an understanding that there are a number of centres that will never meet the criteria for registration. I ask again if this is the case. Does such a list exist? If it does, we have the alarming and incredible situation of residents who need care living in substandard care conditions with no prospect of the situation being appropriately addressed while those facilities remain in service.

I have a great respect and regard for HIQA and its work. It is appropriate and important to register that fact here this morning. I hope the issue of resourcing, to which I have referred, strikes a chord with the Minister of State. I believe it does and hope that in his position as Minister of State with responsibility for the disability sector he will help to ensure that HIQA is resourced and empowered to carry out all the important work it must do in the interests not only of those who cannot voice their own concerns and needs but of all citizens who depend on the State's health and care provision.

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