Kathleen Lynch (Cork North Central, Labour)
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I thank Senators for the opportunity to speak on this issue. It is appropriate that a statement is made here. Elected representatives deserve this courtesy and I thank Senators who raised the issue as it gives me the opportunity to outline the actions being taken by the HSE arising from this very serious matter.

Like others, I was shocked and distressed by the revelations of extremely poor and unacceptable standards of care and mistreatment of vulnerable residents in Áras Attracta. Every person who uses disability services is entitled to expect and receive supports of the highest standard and to live in an atmosphere of safety and care. This is particularly important for vulnerable people in residential care whose families have entrusted them to the care of professional staff. The mistreatment highlighted in the "Prime Time" programme is very disturbing and needs to be fully investigated. In that regard, I welcome the immediate response of the HSE, following receipt of these serious allegations, to alert the Garda and HIQA and for the protection of both residents and staff themselves, to place a number of staff off-duty while the allegations are being investigated. I am assured that staffing levels are being appropriately maintained to deliver safe care to all residents.

I also welcome and support the HSE's initiation of both an expert investigation into these serious allegations, chaired by Mr. Christy Lynch, and an independently chaired review of the services provided at this facility led by Dr. Kevin McCoy. I have been fully briefed by the HSE since it became aware of these allegations and I have asked it to ensure that all appropriate resources are put in place to ensure that the safety and care of residents at Áras Attracta is maintained at the highest possible standard. I have also asked the HSE to brief me on the outcome of these investigations as soon as possible.

I have been assured that the HSE's priority is to protect the very valuable services that people residing in Áras Attracta receive as a critical support to them and their families. I am aware that the HSE has contacted families of residents in Áras Attracta offering to meet with them. I would encourage families and concerned members of the public to contact the HSE's information line at 1850 241 850 from 8 a.m. to 8 p.m. Monday to Saturday. The safeguarding and protection of vulnerable people in the care of the health service is of paramount importance. In this respect, I understand that the director general of the HSE has written to all staff informing them that the onus is on them to take personal responsibility to ensure that the individuals supported by the HSE in any setting are treated with dignity and respect.

The HSE is also considering initiating its own undercover investigations into operations in HSE facilities to supplement the programme of inspections already in place and as part of a suite of measures it is developing to protect vulnerable people. In addition to these initiatives, the HSE's new national policy and protocols for safeguarding vulnerable persons at risk of abuse, which I launched on 5 December 2014, clears the way for staff members in HSE and non-HSE facilities, and members of the public, to refer allegations of abuse to designated reporting individuals. This new policy, which came into force on Friday last, with immediate effect, places an onus on providers of services to vulnerable people to appoint a designated officer to both receive and follow up on concerns and reports of abuse. Under the new policy it is the responsibility of all staff and service providers to ensure the protection and welfare of vulnerable people. In each community health care organisation, a safeguarding and protection team will work in partnership with all relevant service providers to ensure that concerns and complaints are addressed. This policy complements the statutory inspection by HIQA of nursing homes and residential centres for people with a disability and is very welcome.

I also welcome the public appeal made by the chief executive of HIQA to encourage any persons who have concerns about the treatment of vulnerable persons in our disability services to contact HIQA. He has emphasised that the matter will be taken very seriously and looked at in the context of HIQA's significant regulatory powers of inspection of residential facilities. I am very conscious that the events we witnessed in the "Prime Time" programme yesterday happened in the home of these vulnerable individuals. It is incumbent on us to do everything possible to remind the management and staff of our services of that fact and of the need to maintain high standards of ethical behaviour and apply the training and principles of person centred care in everything they do.

I doubt there is an individual in the country who was not disturbed by what we saw last night.

Thomas Byrne (Fianna Fail)
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We were all shocked to the core by what we saw on television last night. Most of us do not watch much television, but last night's programme was what one might call "reserved viewing". Nothing prepared me for what I saw last night. I know a little about this sector as my wife is a nurse and works in a residential care home and is well used to dealing with individuals with disabilities or challenging behaviour. Not all of those in Áras Attracta have challenging behaviour. From my little knowledge of the issue, the challenging behaviour displayed seemed to result from the way the residents were treated and the failure to communicate with them by staff. The lack of communication is often the reason for challenging behaviour. I was shocked to my core, as was everybody in the country who watched the programme.

I never saw such a reaction to a TV programme - on Twitter, on Facebook, talking to people, meeting people, etc. What we saw was appalling, shocking and completely contrary to human decency. I was tweeting during the programme and in one of my tweets I said I felt a bricklayer would handle his bricks more carefully than these special women were handled by some of the staff. Their treatment was outrageous. The Minister mentioned that this happened in their home. This key point was forgotten, namely, that this happened in these people's home. They should be treated as if they are at home and people are well paid to do their job of care. We acknowledge staff have suffered cuts, but theirs is not a bad job. Many people are trying to get into nursing and care services and it does not take a huge amount of professional training to know what not to do in this situation.

I have a number of concerns. Last night after the "Prime Time" programme I watched the discussion, during which the Minister of State said she could not give any assurances that this is not happening elsewhere. She must be able to give these assurances. We need assurances that this is not happening elsewhere. We also need immediate action from her. There must be immediate implementation of the current HSE proposals to ensure the system is operating as it should. One of the big concerns is the pre-announced inspections being undertaken by HIQA. These tend to wind the staff up and put them in a panic about HIQA turning up for the period of time it is there. Everything, of course, will be all right on the day. If visits were unannounced and if HIQA could show up unannounced at any time, people would be aware of that and work on that basis. The way the system operates currently is that the announced inspections do not benefit residents or service users at all but just put stress on staff. This needs to change completely. We need a change of mindset so that we know what is happening.

The undercover actions and secret cameras were essential to what was uncovered and shown on TV last night. Thank God for the people who did that difficult job. I pay tribute to the RTE researchers involved.

There are issues of privacy involved here. I know that RTE had to seek the permission of all the families involved and I am sure it was a big ordeal for them. The Minister of State needs to be able to give people assurances. She needs to do everything in her power, as does the HSE, to make sure that this type of behaviour is not happening in other care homes. Clearly a disgusting culture developed in that place that allowed such behaviour to happen and that allowed people to be treated as less than human. It was truly awful.

I have some other concerns too. Whistleblower legislation was passed in the Houses of the Oireachtas recently which provides that guidelines will be drawn up for staff in the public sector on the implementation of the law in terms of blowing the whistle, so to speak. What has happened in that regard in the HSE? Has the executive issued guidelines to staff? Have the voluntary bodies that run similar care homes issued guidelines to their staff? If people want to blow the whistle on bad practices today, what should they do? Who should they ring? What is the procedure? While somebody like Mr. Ryan who sent a dossier to the Committee of Public Accounts would, as a senior civil servant, be well-versed in the provisions of legislation, the average nurse or care assistant is too busy to read the Protected Disclosures Act. They need to have a simple way of blowing the whistle. I suggest that a hot line be set up immediately so that nurses, care staff or anyone else with an interest can blow the whistle on bad practices. Such people need to be able to ring up and give information, whether to the Department or to the HSE. That information could be critical, dignity saving or even life saving. I would also like the Minister of State to come back in due course and give us an update on the Garda investigation into the activities at Swinford. If an assault were to take place outside the House today, those involved would be arrested immediately and rightly so. The same should apply here and I would urge the Garda Síochána to adopt a similar proactive approach in the case of Áras Attracta. I wish the gardaí the very best with their investigations.

These events have also sullied the name of a great Irish women who is not very well known; St. Attracta who ran a hostel for vulnerable people 1,500 years ago. Her memory has been sullied.

Colm Burke (Fine Gael)
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I thank the Minister of State for making time today to deal with this issue. The television programme aired last night was frightening. People are shocked that in this day and age this way of managing patients was allowed to continue. It is interesting that HIQA carried out an inspection of the facility on 25 and 26 February and again on 26 and 27 May this year. Several issues were identified by HIQA and the indications were that not everything was running as it should be. This shows clearly that where concerns are raised, making sure that the checks and balances are operating properly is essential. It is clear that the management and care of the patients was not being carried out in proper manner. It is also very clear that there were no checks and balances to ensure that proper procedures were being followed. That is a significant issue. Surely the medical staff working at this facility must have been aware of concerns. When patients attend GPs in the context of family difficulties, doctors can often identify issues of concern, particularly with children. What was the position at the facility with regard to medical care? Was the medical well-being of patients being reviewed on a regular basis? If not, why not?

This raises another issue which I have been highlighting repeatedly over the past six months and which came to the fore again last week at the meeting of the Committee on Health and Children which addressed the ambulance service. At that meeting, senior management confirmed that they did not have the skills to carry out the work they were employed to do. They spoke about inadequate job descriptions. About six months ago I raised my concerns about the fact that more than 1,100 staff in the HSE have been appointed to more senior roles without being interviewed. The HIQA report on the ambulance service also raised the issue of staff not having the requisite skills to do their jobs. Given that 1,100 people were appointed without interview, is there now a question mark over whether they have the competence to carry out their roles? Does this also apply to this area? It is fine to put people into jobs but it is important to ensure that they have all of the necessary skills to carry out the job they are employed to do. Certainly in this case, the staff obviously did not have the skills to manage these patients, which resulted in major failings in their care. If they were trained, was that training adequate? If they were not trained, how were they appointed to their jobs? These questions must be answered.

Mary Ann O'Brien (Independent)
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I welcome the Minister of State to the House. I am glad she is here although I wish the debate could be a lot longer than half an hour. I have not slept very much since 24 November last since I visited a young lady called Cliona McCallion in her bungalow, which is not in Mayo but in Kildare. Cliona was born with an extreme form of epilepsy and has severe intellectual disabilities. She is a beautiful young lady ---

Paddy Burke (Fine Gael)
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I must ask the Senator to refrain from naming people on the record of the House who are not here to defend themselves.

Mary Ann O'Brien (Independent)
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She cannot defend herself because she cannot speak. Her family, however, can speak and have spoken at length to me. She cannot talk and is totally dependent on her carers. She is doubly incontinent and her seizures are life threatening. Her blood pressure drops to dangerously low levels and she needs to be near a hospital. However, the bungalow, which is in Nurney, is 45 minutes away from Naas General Hospital, the closest source of oxygen. She is not under nursing care but is looked after by carers. She lived with her family until 14 months ago. Her family is great - her Mammy, Daddy and three fantastic siblings have all helped to care for her. She is now 17, a year away from being an adult in the eyes of the State. She is a beautiful lady but only weighs 65 kilograms. Her family reached the stage where they needed respite and the HSE took Cliona to assess her and placed her in a private nursing facility. She never had a single injury while being cared for by her family but has had four injuries in the past 14 months. She broke her toe and while she had trouble walking before that, she can barely walk at all now. She strained ligaments in her ankle. She fell the other day and injured her neck. She fell against a radiator in the corridor outside her room which is unsafe. She split her lip and was taken to Naas General Hospital but was deemed not to need plastic surgery. She is disfigured for life. I am not, by the way, making any allegations here. I will leave that to the Minister of State's imagination.

Imagine being Cliona's mother. She is very beautiful - I have a picture of her here. Her mother was promised that a male would never be in charge of Cliona. She needs her nappy changed in the middle of the night and care throughout the night. We have found out that three times a male carer was left in charge of this young lady. How does the Minister of State feel about that? Her mother is terrified and appalled. Her mum and dad visit her regularly although her placement is a 120 km round-trip from her home. The only quality of life for this young lady is seeing her family, whom she adores. She recognises them, loves them and they are the only thing she has. She left her little cuddly toy behind in the car one day and her parents drove 15 minutes back to the lovely bungalow where she lives, her room done up by her mum. The carers had the kitchen door shut and were drinking tea while their little girl was unsupervised. Need I say any more?

This evening I spoke to her sister, who is a doctor, and she said she had serious concerns about Cliona's welfare and safety. The HSE officer responsible for the Leinster region - I will not give her name - is, I believe, engaging in a form of abuse against the family. It is not just the child about whom we are talking but five adults in Templeogue who are broken people. The child had to be moved from Crumlin because she was becoming an adult and on 9 July the consultant at St James's Hospital said that, in his opinion, her current living circumstances needed to be reviewed from a safety perspective, as she was living with a very serious medical condition in a social model of care without nursing care. He stated she needed nursing care and needed to be moved. It is only by raising the issue here that I have forced the HSE to attend a meeting with the consultant next week.

I could go on, but this cases mirrors what we saw on television last night and I am just one person dealing with one local in my area. I need the Minister to intervene personally and do something for this family before Christmas, preferably tomorrow.

Mary Moran (Labour)
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I thank the Minister of State for coming into the House to discuss this issue. I proposed an amendment to the Order of Business this morning. Last night I deliberated long and hard as I knew there would be repercussions and I did not do it lightly. I felt something had to be done and I was very disappointed - I still am - that not one other person in the Chamber seconded the amendment. We can all talk about how we tweeted about it and raised it on Facebook last night; we can all talk the talk, but we really need to do something about it. Yes, we are all shocked; everybody is shocked by what he or she saw, but we need to move to do something about it.

Last week it took a death close to Leinster House to have something done about homelessness. There was a death in Áras Attracta in 2012. I ask the Minister to, please, ensure there is not another one before something is done. Looking at the programme last night - we do not need to go back over it again - the hitting and the physical, psychological and mental cruelty were shocking. A manager walked in and sat on somebody and the reaction of the girl in question was to go back over to him. This shows the loving vulnerability of the patients, which is replicated throughout the country.

It was said to me this morning that I was emotional. Yes, I am personally involved and have somebody involved, but I am also deeply concerned about all of the others throughout the country. I have been inundated with calls from people who are upset and who, like me, have family members in care units, but I have also received calls from people who have no knowledge of what is going on. It is welcome that there are investigations, but I ask the Minister what is their timeline. We can talk the talk, but there is a need for urgent action. I dread to think of what things will be like for anybody who will be in respite or residential care tonight.

I have no qualms about the staff who look after my son. The vast majority who work in this area are absolutely beyond reproach, as we all know. It only takes two or three rotten apples to totally decimate the service, but it is not working. It is frightening that HIQA gave Áras Attracta a clean bill of health in May and here we are a couple of months later. I assure the Minister that this is replicated all over the place.

Senator Colm Burke asked how the people concerned were working there. I would like to talk about a service in which last year it was decided to cut all meals. When I asked what would happen to the kitchen staff, I was told they would be okay, that they were all going to have a carer's role. That was grand, if they wanted to perform that role, but they might have been taking on a role to which they were not suited. I am absolutely sure that whoever is there is making it work, but perhaps there are people in these roles who were deployed from other areas and do not want to be there. Last night we saw people who obviously should not have been in these roles. In my book, they should have been arrested today and have criminal charges brought against them. I say this publicly. What is being done? Why are they still on a salary? I know everybody needs to look at it fairly, but based on the television programme, something really needs to be done.

We need to have complete confidence that the most vulnerable are totally safe when in residential care. We talk about the new standards and so on, but, as I said this morning, the only way forward is to have a independent review. We do not need people associated with the HSE involved in this review, no matter how good or half impartial they are. We need those compiling the report to be completely independent of the HSE in order that parents can have complete confidence. I ask that this work continue on Christmas Day and St. Stephen's Day and throughout the Christmas period. We will be finishing up next Thursday, which is one of the reasons I brought up the matter this morning. This issue is going to be kicked to touch and people will say, "Oh yeah, we will have a debate on it." As I said, I cannot go home thinking we had an opportunity to do something but did not take it. In my naivety I came here this morning thinking people would be so horrified that the whole place would be seeking action. Unfortunately, it is not.

It is greatly upsetting that only 2% of the services investigated are fully compliant. We are talking about whistleblowers and people reporting wrongdoings. On the programme last night we heard two people discuss a former employee who had reported abuses and their reaction was that it was brilliant that they had got rid of her. I was speaking to somebody today involved in a similar case who had worked in a service and reported bad practice with her colleagues and who had been bullied out of the place. We cannot let this go on. We can talk about standards, but we really need to put them in place.

Paddy Burke (Fine Gael)
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I am supposed to call the Minister of State at 7.25 p.m. The Acting Leader has indicated he might extend the time allotted for statements. Four Members have indicated they would like to speak.

Colm Burke (Fine Gael)
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I am in the Minister of State's hands. I propose that we extend the time allotted for statements by 20 minutes.

Paddy Burke (Fine Gael)
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Is that agreed? Agreed.

David Cullinane (Sinn Fein)
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I welcome the Minister of State. Our job in opposition is to hold the Government to account and make sure failings are articulated. Part of my contribution will involve that aspect, but before I go on, it is important to say there is no excuse whatsoever for what we saw on television last night. The behaviour of some of the staff at the care facility was absolutely unacceptable and there can be no justification or excuse given by anybody for what happened. The question we have to ask ourselves is why must the voiceless in care depend on whistleblowers or unannounced HIQA inspections or RTE's "Prime Time" programme to expose what we have known for some time - that some of those who work in care homes and other facilities engage in wholly unacceptable behaviour? Not so long ago we had a very similar programme about a creche, a point which needs to be taken on board.

I understand the frustration expressed by Senator Mary Moran. A half hour debate is not enough, but whether we debate the issue for half an hour, an hour or two or five hours is not the issue. The issue - Senator Mary Moran touched on this - is what are we going to do. What actions are going to be taken from all of these debates? What new methods, training programmes and management oversight arrangements are going to be put in place to deal with these issues? One thing is absolutely certain: the job for those involved in caring for people with intellectual disabilities, older people or children is extremely demanding and difficult. I could not do it for love or money; I just would not be able to do it. It is very difficult and people need to be trained to do it. A certain type of person is needed, somebody who has empathy and compassion and can show love.

A certain type of person is required to do that job, somebody who has empathy, compassion and love. That is the reality. However, they also require training. This is very simple in some respects. We can over-complicate it but ultimately we need the right people with the right temperament in the right jobs. There must be proper training, management structures and proper oversight mechanisms.

I read the Minister's speech and I apologise for my absence for part of it. What steps will the Government and the HSE take on this? Steps must be taken to ensure that the highest standards are understood, in the first instance, and implemented by those we trust to look after these defenceless people. That is at the heart of it. These people are incapable of voicing or giving expression to the treatment they are subjected to, and the uncertainty causes great fear for families, parents and siblings. My grandfather was in a nursing home for years and received very good treatment. However, I am sure all public representatives have been approached by people from time to time to complain about how their older loved ones were not properly cared for. These are real problems and they are happening not just in this care setting but everywhere. However, that is not to taint everybody, because the vast majority of people who provide the care are providing the best possible care. They are wonderful people who do a wonderful job. Nevertheless, those who are not must be rooted out, and that can only happen if the proper resources, management structures, oversight and follow-through are in place. We can have inspections but the follow-through is important as well.

I welcome the opportunity to have this brief debate and I look forward to the Government taking action on this issue, which is what we seek.

Tony Mulcahy (Fine Gael)
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The one question that concerns all of us as parents is what will happen to our children and how they will be looked after when we are dead. After seeing the programme last night, I have grave concerns about how our children are looked after.

I heard the chairperson of the psychiatric nurses union speaking yesterday about clinical governance, and Senator Cullinane referred to training. It is not a matter of training somebody to tell them that one does not sit on top of a patient, drag them around the floor or force feed them. That is not about training, that is about how one treats another human being. I have been involved with the domestic violence issue and the type of treatment I saw last night strikes me as much the same. We tend to blame the HSE or its accountability, but the animals who performed in that manner in the programme last night - I can term them as nothing else - unfortunately have the protection of things such as the Haddington Road and Croke Park agreements. The only thing those people should get today is a P45. They should be out the door and down the road.

It is not acceptable practice. They are people with responsibility who are being paid to do the job. Their treatment of the clients was absolutely appalling. Those are the only words that can be used. The Garda might well conduct an investigation as the clients were assaulted, but I believe it is a P45 situation. One gets rid of such people, makes an example of them and starts again. What are the solutions? Must we have cameras monitoring places such as this with some type of oversight whereby they would be monitored appropriately by somebody in that setting? Unfortunately, we might have to do that. Not everybody could monitor that, but I believe that is the required solution from the HSE's perspective. There should be an appropriate monitoring body to monitor these facilities. That is the only thing that will satisfy parents so they will know their children are safe. Their children can range in age up to the mid-70s.

I have been speaking at length about the domestic violence issue since the 1960s, but unfortunately not a great deal has changed in mental health institutions since the 1960s. However, all of these actions are carried out by human beings on other human beings. As I said, I listened to the general secretary of the psychiatric nurses union yesterday and his biggest issue was that there was a lack of clinical governance in this case. It transpired that he had worked there himself. As I listened I wondered if this fellow was for real. What clinical governance? Will somebody tell the person that they should not do that? The person should know they should not do that anyway; they should not have to be trained not to do it. It was the greatest cop-out I have ever heard, instead of criticising some of the union's members and those who were not its members for that behaviour. There were five or six people working in this place at any given time other than at night, which would be normal. There were plenty of staff but the problem was their behaviour.

The only way to deal with this is to have them gone very quickly and teach them a lesson. We can start from there. I will give the Minister whatever support I can. There are parents throughout the country shaking in their shoes today after seeing that performance last night, because one can be sure it is not just happening in one unit, unfortunately. The employees in these facilities need to know that if they are caught, they will be treated appropriately with every measure of the law and lose their jobs. That is final. There is no excuse for these people coming back into any other part of the HSE.

John Gilroy (Labour)
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I will be brief. I am a psychiatric nurse. I spent 27 years in the job and I have a fair insight into the challenges. I watched the programme last night and I am absolutely outraged. I share all the anger that has been expressed.

I heard it being described as a level of care. It is not care at all, but a level of abuse. The word "care" does not enter into it. I listened carefully to my colleagues who have first-hand experience from a service user's point of view and the level of concern, annoyance, anger and frustration in their voices must be taken on board by everybody. We cannot quantify what the difficulty is in our services but we have to think that the overwhelming majority of people working in them are decent, hard-working people. That point cannot be forgotten.

We must approach this in a cool way, despite the level of anger we justifiably feel. I was a little concerned to hear in the early comments from Pat Healy, Tony O'Brien and the Minister on the programme, and the Minister also mentioned it in her statement here, about initiating undercover investigations. There probably is a role for undercover investigations, but not as a first response. I caution against going down this road. As a health care professional one works as part of a team. The nurses, doctors, care assistants, art therapists, physiotherapists, occupational therapist and many other therapists are professionals and must work together as a team. If there is a feeling among the team that one person is there solely to find fault with everybody else, it will undermine the work of the team. That will be the unintended consequence of what we are trying to prevent. I caution against this as a first response.

I recommend that we set up a proper peer advocacy network. I have said this in the House several times. It should be underpinned by statute, be fully funded and provide 24-hour accessibility. This is what we must do. It is a difficult thing to do. It will be a hard job and expensive, but having watched the programme last night I doubt that any money would be poorly spent in this regard. Peer advocacy is the way to go.

Senator Mulcahy rightly spoke about governance. He might have been a little unfair to Des Kavanagh. I listened to the same interview but I did not have his interpretation of what was said. However, I accept the point he is making, which is that without character and temperament one cannot train people to be anything. This is first thing an interview is for, and I was shocked when somebody said earlier that many of the jobs in the HSE are filled without any interview. That is absolutely scandalous. If people do not have the required temperament and character, they have no place working in the caring professions.

This is a very difficult time for the Minister. People are struggling with the issue and demanding immediate answers. Unfortunately, it will take some time to put in place the proper structures to ensure that the most vulnerable people across the entire range of services are fully and properly protected.

Marie Moloney (Labour)
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I welcome the Minister's visit to the House at such short notice. I would have liked the debate to have been a little longer but the Minister has given us this time tonight. I spoke about this on the Order of Business as I was shocked and horrified by what took place.

I worked in a nursing home before I went into politics and I know there are good carers and good facilities across the length and breadth of this country. We must be very careful not to tar everyone with the same brush but as Senator Mary Ann O'Brien said earlier, we have been here before. A year and a half ago we were here talking about the way children were being treated in child care facilities. Before that we were here talking about nursing home facilities. What have we learned from that, and what do we intend to do about it?

I ask the Minister the reason those people were suspended with pay. I worked with a trade union. I know the rules. I know the labour law off by heart-----

Kathleen Lynch (Cork North Central, Labour)
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I know.

Marie Moloney (Labour)
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-----but what more proof do we need than to see the way those people were treating those residents on the programme? They should not be paid. Suspend them, have the inquiry and see if by some chance they can justify it, but there is no justification for the way they treated those residents.

I stated on the Order of Business this morning that we can train those people as much as we want, but we cannot train them to have compassion. We cannot train people to care and to love. It is a natural instinct. If people do not have those basic, fundamental qualities they should not be in the caring profession. We must not put those type of people in charge of our sick, our elderly and our children. That is not the job for them. I do not know the reason such people take up these jobs if they do not have that natural caring instinct. I know because I was in the caring profession, and I loved it. There is a vulnerability and an innocence about the people. Some of them suffering from Alzheimer's disease do not know their own children when they walk in the door. All one wants to do is hold them and hug them, and one has empathy for them because of that. To see a grown adult crying because his mother does not recognise him is heartbreaking. If someone does not have that basic, fundamental quality of compassion, these institutions are not place for them.

The Minister might update the House on the progress of the Assisted Decision-Making (Capacity) Bill and the ratification of the United Nations Convention on the Rights of People with Disabilities.

We must learn from this, and we must do something about it. We must also be cautious about installing cameras in such care homes. We have to respect the residents' rights and their privacy. Where would such cameras be installed? Would it be in their bedrooms? Many of these people wear incontinent pads which must be changed regularly. We must preserve their dignity at all costs but must it always take someone from the media with a camera to go into these institutions and highlight what is happening?

Senator O'Brien has highlighted a complaint but I got a letter today, as I am sure did all Senators, from the Ombudsman telling us that-----

Mary Ann O'Brien (Independent)
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Already been there.

Marie Moloney (Labour)
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-----he will investigate any complaints. As elected representatives it is our duty to bring forward complaints that are given to us. I apologise, a Chathaoirligh, for going over time.

Paddy Burke (Fine Gael)
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Senator Mullins might give a minute of his time to Senator Mullen.

Michael Mullins (Fine Gael)
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I will share my time with my colleague. I thank the Minister of State for coming into the House at short notice. It is critical that all the people at home tonight who are wondering if their loved ones are safe in their particular facilities know that the fact the Minister of State is here tonight is a start in restoring confidence in the service. We must do everything possible to allay any fears people may have about their loved ones who are in the care of others because what we saw last night was shocking beyond belief. What is really worrying is that nothing appears to have been learned from Leas Cross and all the other facilities in which there were problems over the years. We must carry out the investigation quickly, and appropriate action must be taken against anybody found to have misbehaved or ill-treated any person.

I said on the Order of Business this morning that there were two problems, first, bad management of the facility and, second, the recruitment process. What sort of interview process recruited those people who were incapable of delivering the type of care and service required by those vulnerable people? We need to examine our selection processes if they fail us as badly as they have in Áras Attracta. As Senator Colm Burke has been highlighting here, it is frightening that people are being appointed to positions within the Health Service Executive without having the necessary skills or going through the selection process we expect. That issue must be dealt with.

The run-up to Christmas is a worrying time for everybody but the Minister of State, the Minister, Deputy Varadkar, and the Department must ensure that an audit is done as quickly as possible of all the facilities in the State on an ongoing basis to ensure that the level of care we should be providing is being provided.

I join with all colleagues in condemning what we saw on the programme last night and I hope this is the last time we will have to discuss this issue in the House of Parliament.

Rónán Mullen (Independent)
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I thank my cousin and esteemed colleague for sharing time with me. The Minister of State is welcome. It is difficult to imagine how one can take something positive out of the dire and disturbing set of revelations that has emerged. During a brief period of my life I taught social care on a social care programme in the Institute of Technology, Blanchardstown, and one of the buzz phrases that came up time and again was the notion of a reflective practitioner - somebody working in the area of social care being reflective on the job and how he or she does the job. The other concept I remember was that of avoiding models of care that were oppressive. What we have seen are sad examples of practitioners of social care who are not reflective, and have not been reflective, and social care that has been oppressive.

All of us are far beyond the stage where we believe there are only good people and bad people or that institutions are made up of only good people or bad people. We are beyond the stage of thinking that everything was great in the past - we know it was not - and that everything is rosy now; we know it is not. What we can say, however, is that we must first ensure that the law applies where people have committed an offence, whether it is withholding knowledge or whatever. What has come forward in this documentary constitutes evidence, and that evidence has to be used in the appropriate way by the civil authorities in the context of criminal investigations.

Second, we have to recognise that care plan norms only go so far. We need people who have a sense of ethics. There was a time when we would talk about basic Christianity. We can use a wide phrase but the idea of loving and caring in a special way for the most vulnerable has to be recovered, and one cannot just learn that in a college course or through a box-ticking exercise. We must get back to the concept of ethical treatment of other people.

I will leave the Minister with a positive comment, and I thank her for her indulgence. In the same place in Swinford something very positive is happening. A new treatment for autism, the rapid prompting mechanism, RPM, is being practised and explored by families and it has been a liberating experience for children with autism who are now enabled to communicate their feelings. A child describing how he felt before using RPM said he was terrified but now that he can express himself he now describes himself as liberated because he can communicate his ideas and feelings. Not everybody we are talking about has autism but I suggest this is a very positive development that I have already raised in this House with the Department of Education and Skills. We could have the Department explore what can be done to assist children with autism who might benefit from the rapid prompt mechanism system of treating autism. It is very exciting for the parents and families involved, and for the teachers involved. How ironic and instructive that it should be going on in Swinford among other places. I ask that that issue would get attention in these days.

Kathleen Lynch (Cork North Central, Labour)
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In terms of those who stood and watched, what the Senator spoke about used to be called sins of omission. That is part and parcel of the new document on protecting vulnerable adults. There is a reference in that document to omission and being witness to something that is wrong.

In response to Senator Mullins, I believe we have learned something. I have learned something from this entire process. We were a country that denied everything. Once it happened in an institution we denied it. It did not happen, and we continued to deny it until it was undeniable.

I do not intend to do that. It has happened. Hand on heart, I cannot tell Senator Byrne that it is not happening in other centres. I would love to be able to confirm that for parents, siblings and families who are seriously worried about their loved ones. I cannot, however. It would be false and unwise for me to do that. The only comfort I can give is that we will do our very best to ensure what we saw last night is unacceptable. I take Senator Gilroy’s point that not everyone working in this area does what we saw last night. With the level of interest today, a clear and strong signal needs to be sent to those working in the area that the type of behaviour we saw on last night’s programme is not just unacceptable but will not be tolerated.
When Senator Moloney made her contribution, I smiled because I recalled she worked closely with a particular trade union. Recently, a social worker in the Baby P case in the UK won a substantial award in court because due process was not followed in her dismissal arising from the case. We certainly do not want to give anyone involved in this case an excuse. There are three ongoing investigations. As a result of one of these investigations, we will determine what the disciplinary measures will need to be. Whatever the recommendations are, they will be followed. As we speak, the Garda is already examining 190 hours of video material it is received from the programme's makers. We have requested the material ourselves but I am not certain we will get it. Mr. Christy Lynch has personally written to the programme’s producer seeking the material too.
The HSE, Health Service Executive, has set up a special helpline, similar to the one for reporting cases of elder abuse. Working in close proximity with people can make it difficult for nurses and care workers to challenge their colleagues in certain circumstances. However, when they go home, they can pick up the telephone or drop a line to report abuse. Not acting is no longer an excuse and certainly not acceptable.
For 20 years I have been listening to those who deal with people with intellectual disabilities on the need for an independent inspection regime of care homes. We introduced that regime which is now over a year old. HIQA, the Health Information and Quality Authority, would never have picked up this type of behaviour. If we are sensible and have any experience of the world, everyone knows the minute someone highlights such behaviour, be it a family member, care staff or HIQA, the behaviour will change. We do need an additional suite of measures.
People working for too long in the same setting can lead to familiarity. As we know, familiarity sometimes brings contempt. We need to ensure more of a flow in staff.
HIQA made 59 recommendations for Áras Attracta which were all implemented. Up to 400 additional hours of training were put into this centre. I agree with Senator Mulcahy on this business of properly trained staff. We are talking about five qualified nurses and care assistants with qualifications up to FETAC level 5. That is not substandard training. Perhaps people make the wrong choices when it comes to whatever section in which they want to work in the health services. It is still no excuse. If one feels one is in a job that one does not like, especially when dealing with vulnerable people, then there are other areas of the health service that could do with one’s help.
While I cannot say, hand on heart, this behaviour is not happening elsewhere, the clear signal needs to be sent to the wider system that it is not acceptable. I hope people will take account of the new whistleblower legislation. Maybe we have not been forward enough in this regard and need to have a publicity campaign to reassure people that if they come forward with information on such behaviour, even anonymously, then it will be acted upon.
This is such a serious issue that the more we speak about it and the more it gets out to the wider system, the more protection will emerge. I am not certain we will ever be able to say that every single care unit of the 900 in the country is entirely safe, however. All we can do is our very best that it does not happen. What is interesting is that type of behaviour was not going on in the other bungalows in Áras Attracta. I think it was familiarity and the through-flow of staff is important. In mental health, we have been trying to get those working in acute units to work in the community for a time and vice versa. This ensures a free flow and turnover of staff to allow them to understand when someone is admitted and discharged.
I received several calls today from families who entrusted a family member who they love very dearly into what they thought was a good care setting. They informed me they will visit more often now and do so unannounced. A locked door is no excuse. There should be no locked doors. Some units may require a locked door for residents who may wander or harm themselves but these are very few. As for challenging behaviour from the ladies on last night’s programme, I would be challenging myself if I were treated like they were. I did not see any behaviour that could not be dealt with properly. As we speak, there is already a team of three experts in this area dealing with that type of behaviour in Áras Attracta and giving the new staff the necessary type of training for them to properly deal with those with challenging behaviour.
I knew of this for the past two weeks. It is not as if when it was reported that nothing happened. It happened instantly. The Garda was informed and has an investigation under way.

HIQA was informed and the HSE has a service improvement team in place as well. We are working hard on it. As Senator Gilroy rightly said, it is not a time for knee-jerk reactions. I agree with Senator Gilroy completely in that regard. Certainly, we need to do more than we have been doing.

Paddy Burke (Fine Gael)
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When is it proposed to sit again?

Colm Burke (Fine Gael)
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At 10.30 a.m. tomorrow.