Holly Cairns (Cork South West, Social Democrats)
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169. To ask the Minister for Health if he will outline the routes available to persons wishing to report alleged abuse in nursing homes. [15503/23]

Holly Cairns (Cork South West, Social Democrats)
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170. To ask the Minister for Health the steps he is taking to tackle abuse in nursing homes. [15504/23]

Mary Butler (Waterford, Fianna Fail)
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I propose to take Questions Nos. 169 and 170 together.

Safeguarding adults who may be at risk of abuse, harm, and neglect by others in the context of their interactions with the health and social care sector, including in nursing homes, is a key objective of the Department of Health, every statutory body under its aegis and every relevant service that interacts with such adults.

In the health and social care sector, a framework of standards, policies and procedures for safeguarding adults who may be at risk of abuse, harm, neglect, and exploitation within the sector, including in nursing homes, is in place, and further measures are being developed to strengthen this framework.

Existing governance measures

Key governance provisions currently in place include:

- The significant inspection and other regulatory powers of the Health Information and Quality Authority (HIQA) and the Mental Health Commission in relation to the quality and safety of healthcare and social care provision generally (under the Health Act 2007 and the Mental Health Acts).

- The roles of health and social care professional regulatory bodies (including CORU, the Irish Medical Council, the Nursing and Midwifery Board of Ireland, the Dental Council of Ireland and the Pharmaceutical Society of Ireland) in relation to, inter alia, professional registration requirements and professional codes of conduct.

- Joint National Standards for Adult Safeguarding developed by HIQA and the Mental Health Commission and approved by the Minister for Health, that apply to all regulated health and social care centres.

HIQA has advised that:

- It takes a proactive approach to inspecting the provider systems in place for safeguarding residents.

- All statutory notifications of abuse are reviewed, risk rated by an inspector of social services and a decision taken as to the regulatory action required as soon as possible and no later than 5 days following receipt of the information.

- Safeguarding is reviewed on inspection and inspector will speak with residents, relatives and staff.

- In all situations, the Chief Inspector continues to monitor the actions of the provider to ensure they are effective in addressing the safeguarding concerns and ensuring that residents are supported and safeguarded.

- The Chief Inspector can, and has, taken further action, up to and including the cancellation of registration, where providers fail to sustain improvements to residents’ safety.

- All inspectors of social services receive training as part of their role which includes how to assess compliance with safeguarding regulations.

- In addition to having published the National Standards for Adult Safeguarding in 2019, HIQA together with the Mental Health Commission have developed online resources to support staff working in services has developed and 27,976 people have completed the online Adult Safeguarding course since it was launched.

- HIQA, along with a number of other organisations, strongly supports the work of the Department of Health on the development of safeguarding policy for the sector and related underpinning legislation.

In addition, significant regulatory reform has been undertaken or is under way in conjunction with HIQA in line with the COVID-19 Nursing Home Expert Panel’s recommendations and lessons from the pandemic. In this regard,

- The Department of Health entered a new contract for the continued delivery of the Patient Advocacy Service (PAS) and the expansion of the service to residents in private nursing homes, effective from 1 November 2022.

- The PAS service was available already under the previous contract to residents in Health Service Executive (HSE) and voluntary nursing homes.

- The PAS service provides a free and independent national service which helps people using healthcare services to make a formal complaint regarding the care they have received.

- PAS is a critical support service for patients, residents, and their families who have been through a serious patient safety incident or who are making a complaint about healthcare services.

- The PAS will extend its services this year on a phased basis to private nursing homes, with the focus initially on building awareness of the service.

- To support this extension of the service to private nursing homes, amendments were made in December 2022 to the Regulations on Care and Welfare of Residents in Designated Centres for Older People to provide clarity on residents’ right of access to independent advocacy services, and came into effect at the start of March 2023.

- The Regulations were also amended to enhance and standardise requirements in relation to complaints processes, including introducing prescribed timeframes and requirements so that key personnel are suitably trained to deal with complaints.

- Funding was provided to the HSE in 2022 to recruit a Social Worker and a Social Worker Team Leader in all nine Community Health Organisations (CHOs) to work with the safeguarding teams/Community Response Teams currently in place in the CHOs. 12 of the 18 staff have been recruited / positions have been filled.

- Funding has been made available in 2023 to provide for the recruitment/filling of outstanding positions.

Existing operational safeguarding measures

The existing framework also includes a range of operational structures and procedures, including in particular the HSE’s national operational adult safeguarding policy Safeguarding Vulnerable People at Risk of Abuse – Policy and Procedures (2014), which is in place primarily in all HSE and HSE-funded social care settings. The HSE has put in place a range of structures and processes to support and further develop its national operational adult safeguarding policy, including:

- A HSE National Safeguarding Office leading policy development and oversight.

- Clear guidelines set out in the existing policy for HSE and HSE-funded staff to follow in cases of suspected abuse or neglect of adults at risk (including a “zero tolerance” approach to abuse, meaning that abuse must be reported by staff in all instances).

- An adult safeguarding policy and procedures training programme, and a requirement that staff must attend training (the training is also accessible to non-HSE and HSE-funded services).

- A specialist Safeguarding and Protection Team in each of the 9 HSE Community Healthcare Organisation areas.

- Over 2,000 designated safeguarding officers nominated by service providers and provided with additional training.

- Implementation planning for a revision by the HSE of its operational adult safeguarding policy which is expected to extend the policy beyond the social care pillar and to all HSE and HSE-funded services.

Cross-sectoral legislative provisions relevant to adult safeguarding are also applied throughout the health and social care sector, including, for example, legislation on vetting and on obligations to report information to An Garda Síochána of about the commission or suspected commission of certain offences against vulnerable adults or against children.

Policy and legislation development – health sector

The Department of Health remains committed to ensuring that the best possible safeguards are in place to protect any of our service users who may be at risk of abuse, including such services users in any setting where health or social care services are provided to them (for example residential care services, acute hospital services, services in non-acute hospitals and units, home support services, day care services and primary care services).

Work to develop health sector adult safeguarding policy and legislation, building on the robust structures already in place, is at an advanced stage. The policy will apply to all public, voluntary and private healthcare and social care settings and agencies under the Department’s remit.

Significant policy development work has been undertaken to date, including completion of the stakeholder consultation and primary evidence development phases of this major and complex policy project:

- A high-level inter-sectoral Steering Group was established to assist the Department in its development of the policy.

- The Department commissioned the Institute of Public Health (IPH) to undertake focus groups with cohorts of health and social care service users who may be affected by the national adult safeguarding policy for the health and social care sector, to ensure their voices are heard during policy development. A total of 12 focus groups were held, with 82 participants, between November 2019 and March 2020. The report was published in February 2021.

- The Department engaged with key stakeholders in relation to the development of the national sectoral policy and the resulting output pack detailing stakeholders’ feedback is posted on the Department’s website.

- An independent international research evidence review to inform the policy for the sector was commissioned by the Department and published in February 2021.

- Updates and related papers such as presentations to the Steering Group and discussion papers on the policy content are published on the Department's website.

The Department is now preparing for a public consultation and costing study on a draft health sector policy on adult safeguarding and aims to submit a costed draft policy to Government for its approval later this year.Subject to Government approval of this national sectoral policy, legislation as required to underpin the approved policy will thereafter be prepared. The introduction of safeguarding legislation remains a priority for me.

Further regulatory framework reform

The Government is committed to the reform of the regulatory framework governing nursing homes and has approved the inclusion of a Health (Amendment) Bill on its legislative agenda. The General Scheme of this Bill was published in October 2022 and pre-legislative scrutiny by the Oireachtas Joint Committee on Health completed on 6 December 2022.

The purpose of the Bill is to introduce legislation to amend the Health Act 2007, to enhance aspects of the regulatory framework for designated centres regulated under the Act. The ultimate objective of these proposals is to drive improvements for people living in these centres.

A key driver for this legislation is the report of the COVID-19 Nursing Homes Expert Panel, which made a series of recommendations, not only in relation to the response to COVID-19, but also in relation to reform across the nursing home sector. The Bill addresses the Panel’s recommendations regarding the requirement to modernise and enhance the regulatory framework governing nursing homes and the need for mandatory reporting of data by nursing home providers.

The need for reform of the regulatory framework has also been identified in a number of reports from HIQA. It has been agreed that a programme of regulatory reform in the nursing home sector will be pursued on a phased basis, with initial enhancements provided for in this legislation.

The intention is that the initial enhancements addressed by the Bill will span two thematic areas: firstly, providing for a broader suite of enforcement tools available to the Chief Inspector of Social Services and secondly, the collection, sharing and publication of key data on designated centres. Drafting of the Bill by the Office of the Parliamentary Counsel is ongoing.

As part of a second phase of work, the Department will undertake a further, more comprehensive review of the regulatory framework.

Reporting routes

HIQA has advised as follows regarding available reporting routes in relation to alleged abuse in nursing homes:

- All providers of nursing homes are required to have in place policies and procedure to ensure residents are protected from abuse.

- Training for staff is required to ensure that they can recognise, respond to and report any suspected abuse or allegations of abuse.

- In situations where substantiated safeguarding issues are identified, providers are required to take action to ensure the safety of residents.

- If immediate risks to the safety of residents are identified, providers must take immediate action to address these issues and to prevent a recurrence and this can also include where required referral to An Garda Síochána.

- Registered providers are also encouraged to engage the expertise of the local safeguarding teams.

- In addition providers are required to notify the Chief Inspector in HIQA of any suspected, alleged or actual abuse within 3 days in line with regulatory requirements.

- If staff in a centre are concerned that a provider has not taken appropriate action, they can contact the HIQA concerns team.

- All concerns are logged and passed to an inspector of social services to assess and respond to.

As the question of available reporting routes in relation to alleged abuse in HSE or HSE-funded nursing homes is an operational matter, I have referred the question in that regard to the HSE for direct response to you.

Finally, it is important to note that if a case of abuse is suspected to be a criminal matter, it should also be reported to An Garda Síochána for investigation and appropriate action.