Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Senator Kelleher for bringing forward this Bill today. The Government supports the principle of providing a legislative basis for the safeguarding of vulnerable adults. At a personal level, I welcome Senator Kelleher's efforts to progress legislation in this area. The Minister of State at the Department of Health, Deputy McGrath, was scheduled to take this debate on behalf of the Government, but I wanted to be here for the start of the debate to show my personal commitment to working with Senator Kelleher and all Senators on all sides of the House to try to make progress in this area.

The issues covered in Senator Kelleher's Bill are complex and broad, as the Senator has acknowledged. They extend far beyond the scope of the health sector alone or of any one Department. Strong collaboration and joined-up thinking will be required from a number of Departments and State agencies to ensure we provide the best legislative solution to safeguarding vulnerable adults across all services provided by the State.

Senator Kelleher knows these areas well and I am keen to extend my thanks to her. It is a particular pleasure to do so in front of her family, who have travelled to be with her this evening. I extend my thanks to Senator Kelleher not only for this substantial work, this Private Members' Bill, but also for the work she has put in over many years with vulnerable people, including her work with the Simon Community, the Cope Foundation and the Alzheimer Society of Ireland as well as on children's issues in the UK. I greatly value her expertise and input and I look forward to working with her on these matters.

The safety and protection of vulnerable people in the care of the State is paramount. A framework of policies and procedures is in place in Ireland for the safeguarding of vulnerable people at risk of abuse. I will outline some of these measures shortly, but it must be noted – this is important and represents a collective failing on the part of all of us - that there is no statutory framework underpinning these policies. I agree strongly that a legislative basis must be provided for this safeguarding.

The development of appropriate legislation is under consideration. This is a broad tranche of work that will involve an extensive scoping exercise across a number of different sectors to determine the precise nature of legislation involved. To this end, I sought the assistance of the Attorney General in liaising with the Law Reform Commission to conduct research in the area, as per the Law Reform Commission Act 1975. Consultation will also be required between relevant Departments. The most relevant Departments include the Department of Justice and Equality, the Department of Social Protection, my Department, the Department of Finance and the Department of Public Expenditure and Reform as well as others. We need to identify the current legislative gaps in the protection of vulnerable adults. Public consultation with stakeholders will be necessary as well to allow affected parties to express their views. It is important we hear their views and voice regarding improvements to the current system. By identifying the major legislative gaps and the preferred approach to addressing these issues in the context of the considerations of the Law Reform Commission on these matters, the Government will be in a position to determine the Departments most equipped to lead on the development of legislative solutions and the agency or agencies to be tasked with implementation. We know that implementation in this country is key. All of these processes will need to feed into the refinement of the Bill to promote adequately and effectively the safeguarding of adults at risk. That is the point we all want to get to as quickly as possible.

Before looking at some of the specific measures in the Bill, I will outline current policy and how it is being implemented. This is an important context to any debate on the matter. The Health Service Executive published its national safeguarding policy and procedures document, Safeguarding Vulnerable Persons at Risk of Abuse, in December 2014. The origins of this policy lie in the report, Protecting Our Future: Report of the Working Group on Elder Abuse, which was published in September 2002. Following the publication of that report, an elder abuse service was established by the HSE. In 2014, the last year for which figures were published, a total of 2,595 referrals were made to the service. This was an increase of 5% on referrals made in the previous year. Psychological abuse was the most frequently reported form of elder abuse at 28% of all complaints. This was followed by financial abuse, which accounted for 21%. The figure for self-neglect was 21% and the figure for physical abuse was 12%. A total of 66% of referrals in 2014 related to women. Of these, the majority were in the over 80 age category. That category accounted for 54% of cases. The referral rate was nearly four times greater in the over 80s when compared with the 65 to 79 years of age category. Public health nursing was the main referral source, amounting to 29% of referrals. This was followed by hospitals, which accounted for 14% of referrals and family in the case of 13% of referrals.There was a significant increase in the number of concerns that first originated from older people, from 19% in 2013 to 26% in 2014. This increase shows that more older people were referring and reporting abuse directly to the services.

The HSE has established a number of structures to implement its national safeguarding policy, including a national safeguarding office and a national safeguarding committee. Safeguarding and protection teams to deal with suspected abuse have also been established in each of the nine community health care organisation areas. These teams are managed and led by a principal social worker and staffed by social work team leaders and social workers. Staff training is ongoing, with a target to train a minimum of 17,000 staff in safeguarding during 2017. Over 900 existing care staff have been assigned as designated officers in service settings within the HSE's social care division to receive concerns or referrals of abuse.

The national safeguarding committee was formally established in December 2015 and includes multi-agency and inter-sectoral representation. The committee is independently chaired by Ms Patricia T. Rickard-Clarke. I welcome Ms. Rickard-Clarke and her colleagues to the Seanad this evening and thank them for the huge body of work they have undertaken and note the important role it will have in inputting into any legislative solution. The committee has agreed terms of reference but its overarching remit is to support the development of a societal and organisational culture which promotes the rights of persons who may be vulnerable and safeguards them from abuse. Its remit extends beyond abuse of older people, those with mental health conditions or people with disabilities. Importantly, as both Senators Kelleher and Dolan have alluded to, the committee recognises that any vulnerable adult can be subject to abuse and that vulnerability can be a transient or permanent state depending on many influences. Any of us can become vulnerable at a certain point in our lives.

The national safeguarding committee published its strategic plan for the period 2017 to 2021 on 20 December 2016. One of the strategic objectives it identifies is the initiation of conversations with Government and the Oireachtas on the development of legislation on adult safeguarding. I welcome this. The work of the committee to date has confirmed that the scope of the issues relating to the safeguarding of vulnerable adults goes far beyond just the area of health and that a much broader, cross-sectoral approach is needed. Senator Kelleher served as a member of the committee on its formation. The involvement of the committee will be a key factor in the successful development of legislation. Perhaps the pre-legislative stage could provide an opportunity for further discussions and input from the national safeguarding committee directly to an Oireachtas committee.

Following Government approval in November 2015, I had the pleasure of launching the national patient safety office, NPSO, in December 2016. The aim of the office is to give policy direction and leadership in order to bring about improvements in patient safety to a health system that has been the subject of numerous investigative reports on patient safety incidents in recent years. The NPSO is developing a patient safety complaints and advocacy policy. This is in line with recent commitments to examining the complaints process as set out in the Health Act 2004 and associated regulation. The work has commenced with an examination of existing complaints models and systems internationally and a scoping exercise in respect of what exists in Ireland has been completed. The HSE’s Your Service, Your Say policy is currently being updated. In addition, patients can make complaints to the Ombudsman and to service and professional regulators.

The Adult Safeguarding Bill 2017, which we are debating this evening and which was published by Senator Kelleher, proposes the establishment of a national adult safeguarding authority with the objectives of promoting the safeguarding of adults at risk, and reducing the abuse and harm of adults at risk.The functions of the proposed authority would include: the undertaking of investigations where the authority believes on reasonable grounds that there is a risk of abuse or harm to an adult at risk; receiving reports from mandated persons under the legislation; promoting standards and providing information to adults at risk; and supervising compliance with duties imposed under the legislation. The Bill also includes measures to provide for: the provision of an independent advocate to an adult at risk who is the subject of an investigation; the appointment of authorised persons to conduct investigations and receive reports, and the imposition of a mandatory reporting obligation on broad list of mandated persons. These issues will need to be thought through very carefully and I am glad the Senator has agreed that detailed pre-legislative scrutiny is the best forum in which we can iron out this detail and hear from all of the appropriate stakeholders.

I will now deal with some of the issues in the Bill and I do so to be helpful. I hope they are seen in the constructive manner in which they are meant. This is intended to spark the debate about how we can best progress the legislative underpinning of this important area.

A key element of the Bill is the establishment of a new authority to undertake investigations and receive reports from mandated persons. As a Government, we would prefer, as a general rule, to see new functions allocated to existing bodies, to avoid the large cost or, at times, extensive delays associated with the creation of an entirely new organisation. That is a matter that can be teased out further in the context of whether it is better to have a new authority or whether there is an existing authority that could fulfil that function, and the pros and cons of this.

In respect of the health service alone, consultation will be needed with the HSE and regulators such as the Mental Health Commission and HIQA. The remit of the proposed authority would be much wider than the existing HSE safeguarding and protection teams, the remit of which extends only to HSE and HSE-funded providers of disability and older people’s services, including private nursing homes. We need to establish how we ensure that we capture a broader range of responsibilities than those relating to the existing safeguarding and protection teams.

The proposed authority would have the power and duty to investigate allegations in relation to any adult who may be vulnerable wherever they may reside and regardless of their connection with statutory services. The relationship between the proposed authority, HIQA and the Mental Health Commission would also need to be clarified and discussed in further detail. In addition, consultation would be required with a broad range of stakeholders across the range of affected sectors to determine the best model prior to any final decision being made.

The HSE has an extensive staffing system in place for the protection of vulnerable adults at risk of abuse. There are in the region of 60 staff employed in safeguarding teams in the community health care organisations, which are managed and led by a principal social worker and staffed by social work team leaders and social workers. Extensive staff training is in place, as I have outlined, and over 900 designated officers have been appointed in service settings within the HSE’s social care division to receive concerns or referrals of abuse.

It would be important, at the pre-legislative stage, to ensure complete clarity between the roles of the proposed authority and those already in situ in the HSE, and to avoid overlap of functions, for example, in respect of training, publicity and the categories of authorised and mandated persons. In addition, under the functions of the proposed authority, there is a lack of statutory obligation for it to have regard to resources available to HSE or any other public body with which it may have dealings. This is something that is included, for example, in section 8(2) of the Health Act 2007 whereby HIQA must have regard to the resources of the HSE in carrying out its functions. That matter would be worthy of discussion at committee.

Notwithstanding the issue of best practice, the proposals included in the Bill would need to be costed at a later stage. Any additional services would need to costed in a detailed form and resourced properly, and details of this would need to be included in the Estimates and budgetary process that we need to go through in both Houses on an annual basis. Detailed scoping work would need to be carried out by all relevant Government Departments to cost these services so that we could have them in place when the time comes for Estimates and budgetary discussions.

The Bill, as drafted, relies heavily for the provision of independent advocates on the Assisted Decision-Making (Capacity) Act 2015. It is important to state that this Act is being commenced on a phased basis. New administrative processes and support measures, including the setting up of the decision support service within the Mental Health Commission, must be put in place before the substantive provisions of the Act come into force. A high-level steering group comprising senior officials from the Departments of Justice and Equality and Health and the Mental Health Commission is overseeing the establishment and commissioning of the decision support service and this work is ongoing. It is not possible to provide an exact timeline for the full implementation of that Act. That, again, is an example of the discussion that we would need to have including the Department of Justice and Equality. Pre-legislative scrutiny might provide that opportunity.

A substantial number of new powers and responsibilities are proposed in the Bill, including the proposed investigation process, the right of entry and inspection by an authorised person, the mandatory reporting by mandated persons and the schedule of persons to be specified as mandated. All of these matters will require careful legal consideration before their appropriateness can be determined. In outlining the issues that need to be teased out, I want to make clear that I am not dismissing the provisions in the Bill or undermining them in any way. Rather, I am seeking to provide a roadmap in respect of the issues we need to discuss at the pre-legislative stage. We need to hear from the relevant stakeholders and regulators - HIQA, the Mental Health Commission, the HSE, other Government Departments that have a role to play - and, most importantly, from the people we are trying to protect on these issues. These are some of the matters that will require further discussion and that is why I welcome the opportunity to do that at pre-legislative scrutiny stage. I do not see that as an effort to stall in any way what we all want to achieve, namely, the underpinning of the safeguarding of vulnerable adults on a statutory basis. I remain absolutely committed to working with Senator Kelleher in that regard.

I sincerely welcome the platform provided by this debate to put on record the Government’s position on the safeguarding of vulnerable adults in Ireland.The safety and protection of vulnerable people in the care of the State is paramount. It is an area in which we have failed collectively time and again as a State. We clearly need to do something because what we have done to date has not been adequate, and we have seen many an example of that in recent weeks and months.

I agree that this protection should be and must be placed on a statutory basis in an appropriate way. My Department is committed to working with all other relevant Departments and stakeholders to put comprehensive and effective legislation in place. We need to have that broad consultation and we need to have the legal advice necessary to make sure we get this right in the interests of those whose needs we must prioritise.

I sincerely thank and congratulate Senator Kelleher on introducing this Bill. I look forward to working with her and colleagues in both Houses to ensure we progress the principle of what we are trying to advance to ensure that the most vulnerable in our society receive the protections that they require.