Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the Senator for raising this issue today. If the family are watching now or will watch the recording later, I acknowledge their involvement in their son's and brother's care. I have to apologise for the lack of engagement, communication and consultation with the family. I will take more details from the Senator when we finish. If there is a timeline, as has been put on it, and this young man wants to return home, as is his will and preference, that is what the decision support service is all about. That is the role of the DSS. I will work with the Senator on that. Timelines are important.

To get to the crux of the matter, while the HSE endeavours to provide services as close to home as possible, this can be challenging in residential placements. Demographic challenges associated with the increase in the number of people living with a disability, the increase in age and life expectancy and the changing needs of people with a disability have all led to the need for increased residential facilities. Residential services make up the largest part of specialist community-based disability services funding. As of March 2024, the HSE funds a total of 8,472 residential placements. I will get the information for the Senator on how many are in this jurisdiction, in Northern Ireland and in the UK. The HSE funds and works in partnership with organisations including section 38 and 39 organisations and out-of-State agencies to ensure the best level of service possible is provided to people with a disability and their families within the available resources. Regardless of the type of organisation or its location, mechanisms, safeguards and procedures are in place to provide assurances to the HSE and to support accountability processes for public expenditure on health and personal social services. As part of a HSE-wide requirement to ensure that appropriate governance arrangements underpin the release of the funding of agencies, a governance framework for funded agencies has been developed which ensures a consistent approach in this regard. The framework was introduced to implement the legislative provisions of the Health Act 2004 and to reflect requirements for public accountability where the HSE is legally obliged to account for all public expenditure on health and personal social services.

The framework seeks to provide a level of governance which links funding provided to a quantum of service and provides for these services to be linked to quality standards, with continuous monitoring to ensure equity, efficiency and effective use of available resources. The Regulation and Quality Improvement Authority, RQIA, is the independent body responsible for monitoring and inspecting the availability and quality of health and social care services in Northern Ireland and encouraging improvements in the quality of those services. Through its inspections, reviews and audits, the RQIA provides assurance about the quality of care, challenges poor practice, promotes improvement and safeguards the rights of service users. In the UK, the Care Quality Commission regulates all health and social care services in England. The commission ensures the quality and safety of care in hospitals, dentists, ambulances and care homes and the care given in people's own homes.

To be honest, I hear a lot about the framework but I do not hear about where the engagement takes place between the various bodies and families. That is the crux of the Senator's question and what we will have to seek the answers to - where the level of engagement, communication and consultation take place. While we have the frameworks, in practice, I do not feel or hear it in responses.