Thomas Pringle (Donegal, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Ceann Comhairle for selecting this Topical Issue matter to be brought to the House for this very late debate. It is good to be here. I also express my gratitude to the Minister of State, Deputy Rabbitte, for coming to the Chamber and taking the issue. Her dedication to following through consistently on this matter must be astounding many officials in the Department, I am sure. They would probably like to see her being reshuffled to give themselves some respite. That is probably a sad reflection of where the Department is at, unfortunately.

The governance and safeguarding report into CHO 1 published by HIQA last Friday has confirmed many of the points I have been making on the handling of the Brandon case and the subsequent Brandon report in the public domain for past year and for the past six years through my interactions with HSE management. Importantly, HIQA states in the report, and I have reiterated it many times throughout this saga, that no fault lay with the front-line staff in the centres and that safeguarding concerns were being responded to appropriately at that level. It is important to reiterate this. I know the Minister of State has done so at every opportunity and it is important for the staff and the residents.

As HIQA acknowledges, the problems are in areas of communication, governance and oversight of safeguarding procedures, especially follow-up and sustaining positive change. It points to this occurring at middle management, regional and national management levels. The one point in the report I take issue with is HIQA's assertion that this was prevalent only in the Donegal area of CHO 1. It highlights the Sligo area of CHO 1 as something of an exemplar. If there are problems with the identification, reporting and escalation of incidents of a safeguarding nature in the CHO 1 area, then to my mind it is hard to come to the conclusion the report did, which is that it is only in Donegal. I believe that if an in-depth audit was carried out nationwide, it would find similar systemic failures in management, reporting and oversight, and probably not just confined to disability services either. The previous Topical Issue debate gave us an example of this.

The problems all stem from a basic resource issue. Front-line staff are being asked to do a job for which there is often no capacity. Budgets are dictated from the top down and woe betide the local managers who would be brave enough to raise their hand and say that they cannot do the job with what they have been given. It is an ingrained institutionalised attitude found in management across all levels. It is not a public sector problem; it is a management problem. The other major institutionalised attitude found in management is to admit nothing, bury the problems at all costs and save the company first. Sadly, this is the way it works. It is borne out of an arrogance at senior management level and filters down through the layers unspoken, where people know that to raise their head above the parapet will do their career prospects no good. We only have to look at the performance of the Secretary General of the Minister of State's Department at committee this week to recognise it. It was out of touch and privileged but typical of many at that level, unfortunately. That is the problem we see across the board. This problem can be seen in what has happened in the Brandon case and others. We can say it looks good as a performance at a committee meeting but when it feeds down through the programme to ground level then people get hurt. These people are constantly neglected and it is a real problem. I know the Minister of State is active and will try to sort it out and I pay tribute to her for it. If it were not for her and the work she has done we would not have got this far. I would have been shouting into a vacuum and not getting anywhere. It is important that we raise this issue.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Ceann Comhairle for selecting this Topical Issue matter. If memory serves me correctly, this is our fourth time to have a Topical Issue debate on this and it is normally on a Thursday night and it is normally No. 4. In saying that, I thank Deputy Pringle for raising this important issue for discussion and his continued work and advocacy on such issues in Donegal. I welcome the report by the chief inspector of social services in HIQA into the governance and safeguarding in HSE-designated centres for people with disabilities in Donegal. I welcome the comprehensive nature of the report. It provides clear, practical indications of areas for improvement.

I read the Brandon report which was not made available to the general public. I am still calling on the HSE to make it available. What I have seen in numerous reports that have been published is mirrored in some of what is in the Brandon report. The overview report is the outcome of a regular programme of unannounced inspections by the chief inspector in County Donegal. Eighteen centres were visited in January, bringing the total number of centres inspected in the period from September 2021 to January 2022 to 27. All 27 centres are operated by the HSE.

The chief inspector's regulatory programme followed an escalation of inspectors' concerns about the HSE's governance and oversight of designated centres in Donegal. The purpose of the programme was to assess the HSE's compliance with specific regulations under the Health Act 2007. It is important to recognise that the report found that most residents lived in pleasant comfortable environments and that the centres were managed by experienced and knowledgeable persons in charge. It is also important to recognise that when I travelled to Donegal last October and met family members, they were more than complimentary of the front-line staff. They asked me to acknowledge this at all times, as the Deputy has done this evening. However, the inspections found there was poor oversight arrangements in place in the HSE in Donegal. I wish I could say I was surprised by this but unfortunately some of these issues mirror those outlined in the Brandon report and other HIQA reports from the county.

While substantially compliant with one of the three regulations inspected, the HSE, as service provider, failed to comply with two of the regulations, as has been reported to the Minister for Health. We both received a letter late last year from the CEO of HIQA detailing the agency's serious concerns regarding safeguarding in Donegal. The concerns raised in the letter are echoed in most of the recent HIQA reports. This is a concern for me. Ultimately I, as the Minister of State, need to be assured that services are operating to the highest standards for service users and that families can be reassured their loved ones are being cared for appropriately and their trust in the health service is not damaged.

I took particular note that HIQA states its inspectors found the supervision and governance of centres by middle management and senior management was poor. It is clear from the HIQA report that the HSE can be too reactive to issues instead of being proactive. It does not appear to be a CHO-wide deficit as HIQA notes that in Sligo similar incidents do not occur. It is quite clear that safeguarding arrangements need to be strengthened to ensure any issues that arise are identified, escalated and responded to quickly.

A compliance plan has been submitted to HIQA by the HSE outlining plans to address the governance gaps identified by the chief inspector and improve overall safety. I know HIQA's chief inspector has commenced an inspection programme of individual centres that will take place over the course of 2022 to verify the implementation by the HSE improvement plan.

John Lahart (Dublin South West, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I saw that finger waving at me.

Thomas Pringle (Donegal, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her response. I echo her calls for the HSE to publish the Brandon report even at this late stage. Its constant excuses as to why it cannot publish it do not stand up at this stage and do not wash at all. I think everybody knows that. The HSE probably knows it but will never admit it.

While this HIQA report is good, HIQA is not in the clear itself. It has been compliant to a large extent with what has gone on in Donegal over the years. I am glad to see it has come out now and is doing its job. I hope this continues because it is vitally important. The one thing that needs to be said and cannot be said often enough is that this is not a Donegal issue. It is an issue for the national body. It says in the report that it goes right up to national management. One of the things that struck me as we were approaching the publication of the report was that what happened in Donegal was supposedly not being covered by management in Dublin but then all of a sudden when it went to Dublin, everything changed. We must get to the bottom of what actually happened. I am loath to think that this would be contained to Donegal because we have seen this in the past. The Minister of State will probably remember the Morris tribunal regarding what was happening in An Garda Síochána. The response from officialdom at that time was that it was confined to Donegal and that it was only a Donegal issue. To our cost, we saw that it did not just happen in Donegal. We must make sure that this is not the case in the future. National management must be addressed.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

We all agree that the safety and protection of vulnerable people is paramount and continue to strive to work together for this objective. If one of the reasons why the Brandon report was not published was industrial relations or human resources issues because of the identification of a particular layer in HSE management, well HIQA has done it now.

The chief inspector has indicated that there is an inspection programme in the CHO to verify the implementation of the HSE improvement plan and to confirm where the actions taken by the HSE are effective in delivering safer and better quality support. I am also working with officials in the Department of Health and the Department of Children, Equality, Disability, Integration and Youth to develop some form of review or oversight of safeguarding in Donegal. I have been open about my belief that this needs to be led by an expert, independent person specialising in social care and safeguarding who is independent of the HSE and HIQA. My ask is that the powers that be in the HSE and HIQA work with this independent person or group or be part of the team but it will be led by an independent expert where they can share the findings of whatever reports I cannot publish.

Not too long ago, Deputy Connolly stood behind Deputy Pringle and listed all the reports done on Donegal since 2015 and 2016. By pulling all those reports together, the terms of reference can be identified. Yet again, it would be wonderful to have the co-operation of the HSE and HIQA in terms of working with me to review safeguarding and reassure families with loved ones in centres in Donegal that not only are their loved ones receiving the best possible care but that if an issue is identified, the front-line staff working there will be supported when they identify an issue and will know how to identify issues and patterns. For far too long, we have adopted the medical model when it comes to institutionalised care. We need to look at the social care model, stop calling issues episodes and start understanding where that pattern came from and how to support staff but most importantly, the service user in the centre.

Work is underway and I hope that with the co-operation of the Minister for Health and the Minister for Children, Equality, Disability, Integration and Youth, this will be expedited. We hope to have a framework by June.

John Lahart (Dublin South West, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

So there is no finger this time.

Anne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

No, because the Acting Chairman let me go.

John Lahart (Dublin South West, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Great latitude was given.