Catherine Connolly (Galway West, Independent)
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Deputies might help me to gain a minute or two that were lost through my fault. Tosóimid leis an gcéad Saincheist Thráthúil le Deputies Conway-Walsh and Tully to discuss oversight and accountability of individualised care services at Western Care Association.

Rose Conway-Walsh (Mayo, Sinn Fein)
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I thank the Minister of State for taking this important matter. She will be aware that in 2017 HIQA had concerns that Western Care Association was exploiting a loophole in the legislation and not registering individualised services. HIQA raised these concerns with Western Care Association at the time but the organisation insisted that the individualised care services did not meet the criteria to be registered with the Office of the Chief Inspector of Social Services and be subject to inspections. HIQA raised the same concerns again four years later in 2021. Again Western Care Association argued that no oversight was necessary.

In recent months, a flood of people have come forward to discuss serious issues about the care being provided and the treatment of staff at Western Care Association. Many of the most alarming accounts centred on the care for people living alone in individualised services. Brave and committed workers and former workers at Western Care Association have made protected disclosures and submitted information showing not only that these services should have been registered but that there has also been a significant deterioration in the management and oversight of these services.

Ambiguity in the legislation was used by Western Care Association to avoid HIQA oversight of these services for many years, even though some people receiving care in this way are among the most vulnerable in our county. The legislation as it stands means HIQA does not have the authority to enter and inspect non-registered services without Western Care Association's permission. Last year, Western Care Association agreed to allow HIQA to inspect a sample of five homes where care was being provided. HIQA found that all five should have been registered. Operating unregistered services is an offence under the Health Act 2007. Western Care Association has now confirmed that it has 104 individualised services, of which 47 should have been registered. I call again for an independent investigation to be carried out into how and why this was allowed to happen.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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The issues surrounding Western Care Association were brought to my attention by Deputy Conway-Walsh in my capacity as Sinn Féin spokesperson for disability. I have also had occasion to meet current and former members of staff to discuss their concerns in more detail. Western Care Association offers the opportunity for people with intellectual disabilities to live independent lives in their communities with appropriate support. That is the correct way to go. It is what should be happening. However, if the support is not satisfactory, living conditions are not up to scratch or the support is not sufficient or appropriate, people suffer and the people in question are our most vulnerable citizens.

I commend many of the staff in Western Care Association who go above and beyond the call of duty to ensure the residents live the best possible lives. I also commend the residents and their families for trying to make Western Care Association a success. However, the concerns staff had about some of the issues in Western Care Association were so serious that they were prompted to make protected disclosures. Those disclosures must be taken seriously, the members of staff must be supported and the issues must be investigated and dealt with.

HIQA has had concerns since 2017 that the individual centres were not registered and that a loophole was being exploited to avoid HIQA inspections. In 2021, when it was allowed to inspect a small number of services, HIQA found they should have been registered. There are 104 individualised services. How many of them should be registered? Western Care Association says 47 but why not all of them? This matter needs to be investigated properly to ensure the services that should be registered are registered to enable them to be inspected by HIQA. Given that she has responsibility for disability, the Minister of State, Deputy Rabbitte, must step in to ensure there is proper accountability for what is happening in Western Care Association and the best service possible is being provided.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank Deputy Conway-Walsh and Sinn Féin's spokesperson on disability, Deputy Tully, for tabling this Topical Issue matter. Western Care Association is funded by the HSE under the section 39 of the Health Act 2004. It provides services to more than 700 children, young people and adults with learning disabilities in the catchment area of County Mayo. That is a considerable number of individuals whom Western Care Association supports. Recent matters of concern are understood to relate to regulatory compliance and regulatory protection for certain services. I take on board the point that 2017 is not recent.

I am advised that Western Care Association has 35 designated centres that are registered with HIQA. These designated centres currently provide full-time residential support to 105 people. In addition, Western Care Association supports a further cohort of people by way of what the organisation terms "individualised services". Under the Health Act 2007, the requirement for registration with HIQA applies to residential disability services, including residential respite. HIQA determines which services come within its ambit in accordance with the relevant statutory provisions and the authority is examining this in respect of the organisation.

HIQA also has responsibility for setting standards for healthcare services and monitoring compliance with those standards. It regulates facilities that provide care for those with disabilities to determine whether they are meeting the relevant national standard.

The Chief Inspector of Social Services in HIQA has assured me that her office is actively engaging with Western Care Association and action has been taken to prioritise the safety and quality of care and support residents. Work is ongoing to ensure residents have the appropriate regulatory protection.

An escalated level of inspection activity in Western Care Association has been initiated and the chief inspector's team is engaging with the organisation's board of directors and executive management. The HSE is also engaging with Western Care Association to address any immediate concerns and prioritise actions, with a focus on improving outcomes for persons supported by the organisation. The HSE is working with Western Care Association in the context of its service agreement and service improvement framework process. There is, therefore, a lot of ongoing work between the regulatory body, the HSE, the board and the management.

I thank the people who have come forward and highlighted issues. I thank the staff who work in Western Care Association for the continuous care they give. I also reassure the 700 families who have loved ones participating. We all know that Western Care Association is a fantastic service provider in Mayo. However, we also need to bring reassurance that their loved ones are protected and minded to the highest possible standard. I thank HIQA for what it is doing.

Rose Conway-Walsh (Mayo, Sinn Fein)
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I thank the Minister of State and acknowledge that some work has been done since these disclosures came to light. However, contravention of the Health Act 2007 over such a long period is a very serious matter. The Minister of State must ensure there is accountability for these failures and outline the steps she is taking to ensure this can never happen again, either in Western Care Association or similar care services. Firm and frank assurances must be given that those who have come forward to expose the non-compliance, be they families, former workers or workers, will not be ostracised. That is very important.

It is clear that the 2007 Act needs to be extended to incorporate all services provided to vulnerable users. A holistic approach is necessary, one where HIQA has the powers and resources to inspect all of the services delivered by providers. A culture of providers marking their own homework and deciding whether to invite inspection cannot be tolerated. There is an opportunity to shape an organisation that fosters a culture of transparency, openness, accountability and respect for service users, their families, staff and future staff.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I have engaged with a number of organisations in a similar position, where concerns have been expressed about the management of a centre or the conduct of some staff. Protected disclosures have also been made in these instances. I find that the HSE tends not to run or provide disability services in many cases. It tends to prefer to have section 39 organisations or charities do so. That is fine if there is proper oversight. However, when a budget has been allocated, there is often very little accountability about how it is spent. I am not suggesting it is spent badly or anything like that because much of the service provision is good. However, there are opportunities for fraud and that is happening too. When things go wrong the HSE sweeps in, dismisses a few people and hires a high-cost investigator to come up with a predetermined outcome. Very often, the person who first raised the concerns and made the protected disclosure is scapegoated. These individuals end up being ostracised, as Deputy Conway-Walsh pointed out. That has to stop. These people have to be protected for doing the right thing.

Anne Rabbitte (Galway East, Fianna Fail)
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I again thank Deputies Tully and Conway-Walsh. The Government is committed to providing services and support for people with disabilities, which will empower them to live their lives and provide greater independence in accessing the services they choose. It is important to point out that it is almost a year and a half since the House discussed the Brandon report. At that stage, I looked across the Chamber for support for publishing that report. Deputy Pringle was a lone voice at that stage. The importance and relevance of safeguarding need to be understood. In that case it was the HSE. I do not accept that it is just the charitable organisations that lack scrutiny. They all lack scrutiny and they all need to have a proper framework in place to ensure there is reassurance for the families and proper safeguarding mechanisms are in place for individuals living in care settings. There needs to be an understanding of the culture and relationships within all the organisations. I call on the Deputies to work with me on the Brandon report and on putting in place a proper mechanism in relation to it. If that is sorted, we will have a proper process for the entire country as it relates to reassurance.