Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank Senators for the opportunity to address this legislation. I am pleased to attend the Seanad and introduce the Health (Amendment) Bill 2016. The Bill is a technical amendment to the Health Act 2007 with the sole purpose of extending by two years an existing transitional period provided for in that Act. The transitional period is currently due to expire by 31 October 2016 but this Bill will extend that date to 31 October 2018.

The Health Act 2007 provided for the establishment of the Health Information and Quality Authority, its inspection and regulation of designated centres and the framework for registration of these designated centres. "Designated centre" is the term used in the Health Act 2007 to describe residential centres in three broad categories: those for people with disabilities, those for older people and those for children. The measures provided in the Health (Amendment) Bill 2016 relate exclusively to residential centres for people with disabilities.

It was planned that all designated centres for people with disabilities would be inspected and registered by HIQA or else be refused registration within a three-year period after the relevant section of the Health Act 2007 came into effect. A provision contained in section 69 of the Health Act 2007 ensured that the centres would be allowed to continue operating, subject to the full rigours of HIQA inspection regime, during the three-year period as if they were already registered. This period is now due to expire by 31 October 2016. Due to the complexities of the disability sector and in some cases the significant quality and safety issues identified by HIQA in the first two years of regulation, HIQA alerted the Department of Health in 2015 that it would not be possible to complete a final registration decision for all designated centres which had been deemed to be registered in this way by the end of the transitional period on 31 October 2016.

There are approximately 1,000 residential centres for people with disabilities throughout the country. By June 2016, a total of 556 had been registered - that is to say, 556 are now in the mainstream system. HIQA estimates that more than 350 centres will not be registered by the end of October 2016. It is important to understand the serious consequences if the deadline is not extended. Under the existing legislation, HIQA would be obliged to cancel the transitional regulation of a large number of centres. The Health Service Executive would be required to take over the running of these centres and make alternative arrangements for residents of the centres taken over. This would have major implications for the residents living in the centres as well as significant budgetary, administrative and staffing implications for the HSE and the Department of Health. Moving residents out of these centres would be very difficult, as no spare capacity exists in the disability sector, unlike, for example, the nursing home sector. Where alternative accommodation was available, extreme care would have to be taken with any move to protect the high proportion of vulnerable residents whose needs must be paramount in any decisions made.

The Health (Amendment) Act 2016 is a technical amendment to the 2007 Act with the sole purpose of extending the transitional period by pushing out the final deadline for registration of centres for people with disabilities by two years. The Bill has no impact on the registration or regulation of residential centres for older people or children. It is important to point that out. The proposed two-year extension will not limit or diminish the responsibility of providers to manage and operate the services under their control. That is another key aspect of this legislation. Nor would it limit HIQA in the application of sanctions or powers of enforcement. HIQA is in full agreement with extension of the timeframe proposed in the Bill. Furthermore, no additional cost to the State is involved in extending the timeframe for registration by HIQA of centres for people with disabilities.

In addition to the need to avoid the significant disruption that would be caused by a large number of centres becoming unregistered all at once, the extension of the timeframe for meeting the registration requirements will be beneficial to the process of de-congregation of residential settings. In the disability sector in recent years the settled policy has been one of de-congregation, with large congregated facilities to be closed over time and people living more independent lives in smaller residences in the community. That is something I am pushing at the moment. The extension of the deadline by two years will allow service providers more time to pursue this policy.It will allow HIQA to take a more measured approach in dealing with the problems in these old-style institutional facilities, which were never envisaged as compliant with current standards and regulations, and will help smooth the transition to a fully regulated sector.

One of the key aims of Government is to provide services and supports for people with disabilities that will empower them to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This is a fundamental change in the way services and supports for people with disabilities are currently provided. There is an onus on us to implement this change in a way that works effectively for people with disabilities and is financially sustainable, accountable and transparent. In that regard, underlining this Government's commitment to the disability sector, I recently announced additional funding of €31 million for disability services in 2016. This funding is in addition to capital funding of €100 million over a five-year period and it will be focused primarily on moving people out of congregated residential institutions.

While this Bill will help to facilitate in the move towards de-congregation, it is worth noting again that it will have no cost implication for the State. The Health (Amendment) Bill 2016 is a relatively short piece of legislation, providing only a minor technical amendment to section 69 of the Health Act 2007. As the Bill is technical in nature, to assist Senators, I propose to outline the specific provisions of the Bill to clarify the intent of each.

Section 1(a) amends the key definitions contained in section 69 of the Act. These substitute provisions will ensure that the extension of the transitional period provided for in this Bill will apply only to residential centres for people with disabilities and not to other categories of designated centre. At the request of the Department of Children and Youth Affairs, the definition of "Institution" contained in section 69(l) of the 2007 Act is to be amended to specifically exclude any effect of section 69 provisions on special care units for children. A separate transitional period in respect of these units is set out in section 48 of the Child Care (Amendment) Act 2011. A new definition of "relevant day" is also included in the amending provisions. This reflects the fact that the legislation applicable to the different types of designated centre came into force on different dates for each category. For example, designated centres which are public or private nursing homes have been subject to regulation and inspection by HIQA since 1 July 2009. The "relevant day" when the legislation came into effect for centres for persons with disabilities is 1 November 2013, and this is reflected in subsections (e)(i) and (c)(ii) under the definition of "relevant day" in the new section 69(1) substituted by this Bill. The "relevant day" when legislation came into effect for the other types of designated centre is also provided for, but the transitional period in respect of the other centres is not extended by section 1(b) of the Bill. The clear indication of the different "relevant days" for the different types of designated centres is essential. The original definition of "designated centre" is contained in section 2 of the Health Act 2007, as amended by the Child and Family Agency Act 2013. The Health (Amendment) Bill 2016 as drafted ensures that the measures to extend the transitional period in respect of centres for people with disabilities will not have any effect on the transitional period for any other type of designated centre.

Section 1(b) of the Health (Amendment) Bill 2016 extends the timeframe for a final decision on registrations solely in respect of designated centres for people with disabilities. It does this by replacing subsection (2) of section 69 of the Health Act 2007. Section 1(a) of the Bill defines centres for persons with disabilities as institutions to which paragraph (c) of the definition of "relevant day" applies. Section 1(b) goes on to say that a person who was carrying on the business of an institution and providing residential services at the institution may continue to do so in the case of an institution to which paragraph (c) of the definition of "relevant day" applies for a period not exceeding five years and commencing on the relevant day. This means that centres for people with disabilities would be able to continue to operate without a registration decision until 31 October 2018, five years after the relevant legislation came into effect on 1 November 2013. For all other types of institution governed by the Act, the period of time in which they can operate without a registration decision remains at three years. There is no change for the other centres. While the provisions are complex in their drafting, I would emphasise that overall this Bill seeks to change one small matter relating to the system of HIQA inspection and regulation of centres for people with disabilities. It seeks to make this change without affecting in any way the other types of residential centre, be they nursing homes, special care units or residential centres for children in accordance with the Child Care Act 1991.

The extension of the transitional period in respect of centres for people with disabilities will ensure that all such centres continue to be thoroughly inspected, monitored and assisted to reach the standard of operation required since regulation of this sector commenced in November 2013. It will not in any way limit HIQA in the application of its sanctions and considerable powers of enforcement. That is an important point to remember. The consequences of failing to extend the registration deadline would be severe, both in terms of the impact of a forced change of circumstances on some of our most vulnerable citizens and in terms of staffing and financial implications for the Exchequer.

I thank Senators for their attention to what is a complex but ultimately technical issue. I commend the Bill to the House.