Tuesday, 12 November 2013
Regulatory Impact Assessment Usage
I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House to deal with this matter. It is great to see her.
The issue I wish to raise relates to regulatory impact assessments. We were promised that the Government would cut red tape. "Reform" became part of a ministerial portfolio, the purpose of which was to cut red tape. When I asked how many regulatory impact assessments had been carried out in the Department of Social Protection, I was informed that only one had been carried out. Much bureaucracy and paperwork have been created. In many respects, it is more to do with covering the officials and bureaucrats than improving the system. A red tape report was carried out on Valentia Island. We found that if we could reduce the amount of red tape, 70 jobs would be created. I refer to foreshore licences, planning and other areas.
I wish to focus on nursing homes which are being crippled by red tape. What often happens is that when something goes wrong, as has been the case when patients receive bad care or in certain cases are the victims of cruelty and treated more like prisoners in the 1800s than patients in the 21st century, the follow-on action by the Government involves significant levels of reporting which generates enormous amounts of work for people who are trying to carry on a business. BDO has carried out a cost-pressure survey report on the nursing home sector. Independent commentators have revealed that in the long term the demands placed on nursing homes in terms of pricing are not sustainable. I know the Minister is working hard on that issue. I have been told by people who run nursing homes that paperwork that used to take a couple of hours now takes staff two days to complete and submit. One wonders how many people are required to read the reports.
On a practical level, I accept that the Minister wishes to ensure the necessary care is available, but the over-reaction and bureaucracy created to counteract cases of poor care have stifled the provision of care in some cases and made it unviable for people to continue in the sector at a time when we need more nursing homes, not fewer. People are being squeezed out of the sector, not only because of pricing by the HSE but also because of the level of bureaucracy being created as part of a reporting mechanism. Will the Minister of State outline whether the Government carried out a regulatory impact assessment on the impact of regulations and the practical implications of compliance in terms of staff time required to fill in forms and reporting on an ongoing basis? Was a regulatory impact assessment carried out as to whether we could do it better?
I look forward with interest to the reply of the Minister of State.
I thank the Senator for raising this issue. Before I give the official response, I wish to outline that the balance is delicate because we are dealing with vulnerable people. Because of the approach taken to long-term residential care for older people we must strike the balance well. We do not want regulation and bureaucracy to interfere with the care people receive, but, on the other hand, we must be extremely careful that the type of light-touch regulation we have seen in the past is not applied to a sector which must be regulated and in which we must ensure people receive the best of care.
As the Senator is well aware, Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible and to ensure only the most highly dependent people are in long-term nursing home care. We are dealing with a vulnerable cohort of people and must be careful about how the care is delivered. There is and will always be a cohort of older people who require the long-term residential care option. Residential care for older people is provided in a range of public, private and voluntary facilities throughout the country. In recent years there have been two significant developments in the nursing home sector, both of which were the subject of regulatory impact analyses, RIAs. The introduction of the nursing homes support scheme in 2009 put in place a system of financial support that ensured nursing home care was affordable to all. It is a very generous scheme of assistance under which the State bears the larger part of nursing home costs. Contributions from individuals who choose their own nursing home from an approved list are related to their ability to pay. More than €970 million is allocated to the scheme this year to support more than 22,700 people. Under the Health Act 2007, statutory responsibility for registering and inspecting nursing home settings against national quality standards was given to the Health Information and Quality Authority. Access to appropriate quality long-term residential care is now underpinned by both a strong regulatory regime and an excellent system of financial support.
A regulatory impact analysis was completed in advance of the introduction of both the nursing homes support scheme and the nursing homes standards drawn up by HIQA. The Department of Health prepared information leaflets, A Guide to the Fair Deal and a frequently asked questions document. In addition to dealing with queries and representations from interest groups, public representatives and members of the public, the Department also met interested parties. The factors arising from the RIA were taken into account in implementing the scheme. For the RIA on the national quality for residential care settings for older people in Ireland theDepartment commissioned an independent consultancy to carry out an assessment of costs on the impact of the standards. In addition, a consultation session was hosted in Dublin Castle. The Department has also recently carried out a regulatory impact analysis arising from two changes to the nursing homes support scheme announced in budget 2013. One of the changes was related to the contribution. All three RIAs are published on the Department's website. The Senator will be aware that a review of the nursing homes support scheme is under way and will include a broad analysis of how future overall provision for older people can be made sustainable and best meet people's needs. The review is being carried out by the Department, in collaboration with the HSE. Work will continue on the review in the coming months with a view to completion in early 2014.
I accept the Senator’s point on bureaucracy and form filling, but one must bear in mind that the sector deals with vulnerable people and that it is only the most vulnerable who receive such long-term residential care.
We must be extraordinarily careful that one does not impact on the other and at the end of the day, the care is really what is important.
I thank the Minister of State for coming to the House and I agree with what she has just said. However, instead of having officials in the Department reading the reports and determining whether all of the reports from the various nursing homes were received, we should be deploying more inspectors for surprise visits. We need boots on the ground. As the Minister of State knows, one can read a paper report on a nursing home that does not reflect the reality. When one sees the home in reality, one can understand the situation better. Surprise visits are very effective, especially if those running the homes know they will be inspected once or twice a year. That is a better approach than simply reading reports. I thank the Minister of State for coming to the House and for her efforts in this area.
Senator Daly should be aware that we have just recently employed an additional 48 HIQA inspectors. At a time when we are being asked to dramatically reduce the numbers of staff employed by the State, that is significant. We are prioritising areas where we need additional staff on the ground. Where there is a concern about a care institution, HIQA returns to that institution repeatedly. It is not as if the announced visit is a once-off event and nothing else happens. If there are concerns then those concerns are addressed by continuous, regular visits. It is very difficult to hide something that is wrong if an inspector is constantly at the door. That is what we need. I make no apologies for that happening. The majority of people who deliver care in this country to our older people do an extraordinary job. We hear that from families and the older people themselves. However, that does not mean that we should not be vigilant.