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Dáil Éireann debate -
Wednesday, 20 Jul 2016

Vol. 919 No. 1

Health (Amendment) Bill 2016 [Seanad]: Second Stage

I move: "That the Bill be now read a Second Time."

I warmly welcome the opportunity to address the House today on Second Stage of the Health (Amendment) Bill 2016 which is a technical amendment to the Health Act 2007 and has the sole purpose of extending by two years an existing transitional period in respect of the registration of centres for people with disabilities. I will also take this opportunity to say a few words about the broader issue of the safety and protection of vulnerable people in the care of the State which is of paramount importance to me and this Government. There have been a number of cases coming to light in recent weeks and months which have given me significant cause for concern. I am joined in this reaction by other Deputies in the House today. Unacceptable events and practices, mainly historical but also more recent, are coming to light following the RTE "Prime Time" programme. It reflects an attitude in the past to people with a disability. I have major, urgent concerns and during my watch I will protect and guarantee the rights of all people with physical and intellectual disabilities. It is important.

Let me make it clear today that I am determined that the utmost priority will be given to the full protection of people with a disability in the care of the State. Furthermore, I am determined that historical issues will be comprehensively examined and addressed. The cases in recent media reports are of serious concern but it is important to note they are now coming to light because the system has changed. Things are far from perfect but in recent years we have introduced new policies and regulation to attempt to prevent this kind of event from happening again. Since 2013, all residential centres for children and adults with disabilities must be inspected by HIQA. The regulator is shining a light into every corner of every centre where our most vulnerable citizens live. Notwithstanding the reports we read in the media, most of these centres are providing very good person-centred care and support.

The inaugural annual report by HIQA on the regulation of centres for people with disabilities published last week found evidence of a high standard of care and a focus on individual residents' needs and preferences in many cases. It stated that regulation has brought a cultural change to the sector and has steadily led to improvements in the standard of care provided to residents. My objective will be to ensure that residents are protected from all kinds of abuse. There are exceptions to this and some HIQA inspection reports do not make for easy reading. I totally endorse the work of HIQA. There have been cases where massive improvements have been demanded by HIQA and there have been cases where HIQA has cancelled the registration of centres that are unable to meet the standards required. I emphasise that regulation is a work in progress and it takes time to bed down these new systems. The Bill before the House today is a small component in this system. I will return to its specific provisions shortly.

On Monday of this week, the Minister, Deputy Harris, and I met with HSE officials. We made very clear and outlined our serious concerns about the recent allegations in the "Prime Time" programme and we listened to the HSE on a range of measures that are being implemented and have progressed in recent years to improve these matters. The meeting on Monday was very tough and difficult but we had to put it on the line to ensure the safety of all residents. This includes the Transforming Lives agenda, which is driving the move towards person-centred, community-based care and the roll-out of the critical policy of safeguarding vulnerable persons at risk of abuse. In addition, the HSE confidential recipient, Ms Leigh Gath, is working diligently to assist people who need to approach a person in confidence to have a concern addressed. The confidential recipient is another key part of improving safety for residents. Ms Gath’s first annual report set out a range of cases in which she has been involved and was able to assist people with concerns.

I urge all Deputies, if they have any concerns or issues, to contact Ms Gath.

Regarding some of the allegations, I expect to receive shortly from Mr. Conor Dignam, SC, the report which will feed into the terms of reference for a statutory commission of investigation. This will be established as a priority following agreement on the terms of reference and the approval of the Oireachtas. When this happens, I will be looking for cross-party support in regard to the commission of inquiry and the terms of reference.

I will also receive shortly the independently chaired inter-agency review in regard to the case of "Mary", who lived in a former foster home in the Cork-Kerry region. As soon as the facts are established, I am determined that every required action will be taken.

Actions and developments are in progress. It is important that everybody is reassured regarding these matters. None of these vital changes can take effect overnight; all are works in progress.

I am committed to developing the framework of regulation and investigation to safeguard and protect people with a disability in the care of the State and one part of this Health (Amendment) Bill 2016 which I will now discuss.

The Health Act 2007 provided for the establishment of the Health Information and Quality Authority, HIQA, its inspection and regulation of designated centres and the framework for registration of these designated centres. The measures provided for in the Health (Amendment) Bill 2016 relate exclusively to residential centres for people with disabilities. It was planned that all such designated centres for people with disabilities would be inspected and registered by HIQA, or be refused registration, within a three-year period of the relevant section of the Health Act 2007 coming into effect. This period is now due to expire on 31 October 2016. Due to the complexities of the disability sector and, in some cases, the significant quality and safety issues identified by HIQA in the first two years of regulation, HIQA alerted the Department of Health in 2015 that it would not be possible to complete a final registration decision for all designated centres which had been deemed to be registered in this way by the end of the transitional period on 31 October 2016. There are 1,000 residential centres for people with disabilities throughout the country and by June 2016, 556 had been registered. HIQA estimates that more than 350 centres will not be registered by the end of October 2016.

It is important to understand the very serious consequences if the deadline is not extended. Under the existing legislation, HIQA would be obliged to cancel the transitional registration of a large number of centres. The Health Service Executive, HSE, would be required to take over the running of these centres and to make alternative arrangements for residents of the centres taken over. This would have major implications for the affected residents but also significant budgetary, administrative and staffing implications for the HSE and Department of Health.

The Health (Amendment) Bill 2016 is simply a technical amendment to the 2007 Act with the sole purpose of extending by two years the transitional period which sets out the final deadline for registration of centres for people with disabilities. The Bill has no impact on the registration or regulation of residential centres for older people or children. The exact same standards of safeguarding and protection will continue to exist for residents of the centres for people with disabilities.

The proposed two-year extension will not limit or diminish the responsibility of providers to manage and operate the services under their control, nor will it limit HIQA in the application of its sanctions and powers of enforcement. HIQA is in full agreement with the extension of the transitional period proposed in the Bill and that is why I ask the House for its support today. Furthermore, there is no additional cost to the State involved in extending the timeframe for registration by HIQA of centres for people with disabilities.

The Health (Amendment) Bill 2016 is relatively short legislation, providing only a minor technical amendment to section 69 of the Health Act 2007.

I must ask the Minister to conclude.

The Bill is technical in nature but the provisions are straightforward in amending the definitions of "institution" and "relevant day" and extending the transitional period by an additional two years for centres for people with disabilities. I hope it will be possible for this Bill to receive broad support and I commend it to the House.

As the Minister will be aware from taking the Bill through the Seanad, Fianna Fáil will be supporting this Bill. However, it is somewhat disappointing that the Bill is necessary and that more time is needed to render residential centres compliant with Health Information and Quality Authority regulations. Not all disability residential centres will have achieved the standards required to be registered by 31 October 2016 and, therefore, it has become necessary to move the deadline out by two years. Are the Minister and HIQA confident that all will meet this new deadline?

It must be said that we would all like to see more people with disabilities living independently and that fewer residential centres would be needed. However, as long as we have them, it is important that they are well regulated and compliant with that regulation.

We cannot ignore the background against which we are debating this Bill. There have been many shocking revelations in the past week and it is crucial we tackle these issues head on. On Thursday night last, the "RTE Investigates: Lost in Care" programme exposed how the HSE failed in its duty of care and protection to hundreds of adults with intellectual disabilities - some of most vulnerable people in the country. Many viewers will have reacted with anger and disappointment. Sadly, there may not have been great surprise at the revelations as we are witnessing yet another failure of care by those whom we trust to provide it.

The Minister has had a number of meetings with HSE officials in recent days. I trust he gave them the clear message that this cannot go on and that rather than have these matters exposed by whistleblowers or leaks, we need to know now what other deficiencies remain in the system. What other internal reports are there? Is there more to come? What reassurances can the Minister offer? Has the HSE offered him reassurances and, if so, is he reassured? The Minister must have doubts because we all do. It is simply outrageous that, in many cases, the HSE did not even have a file on the individuals in question and, in some cases, where files existed, the detail and the record keeping were completely inadequate. It is shameful. It is as if the 200 defenceless and vulnerable citizens our health service would not even dignify with a record were seen as non-persons.

In one case, the absence of information led to a vulnerable woman being frequently returned without any supervision to her family home even though it was known that she had been sexually abused in childhood by a family member. We also learned of a man with Down's syndrome who spent his whole life in residential care and went for 16 years without any contact from officials. The HSE states there are no current safeguarding issues. However, I suggest the Minister follows the policy of trust but verifies issues. After all, it is just over 18 months since the Áras Attracta exposé.

Last week's revelations came in the wake of other revelations earlier this year about "Grace" and allegations that children and adults with intellectual disabilities, some of whom are mute, were seriously sexually assaulted at a foster home in the south east. This resulted in almost the last act of the previous Dáil being the establishment of a commission of investigation into the allegations. Five months on, the commission is yet to get up and running and there have been concerns expressed that its scope will now be too narrow.

Is there a case, in view of last week's programme, to set up a more wide-ranging commission to look at all residential centres? Surely, we need to be honest with ourselves and find out the full truth of what happened. Can the Minister or anyone be confident that more revelations will not be made in the months and years ahead?

The Bill we are debating amends the 2007 Health Act which provided for the establishment of HIQA incorporating a new and independent inspectorate and registration authority for residential services. While the 2007 Act was steered through by the former Minister, Ms Harney, the establishment of HIQA was a key element in the health reform programme initiated by Deputy Micheál Martin when he was Minister for Health.

It is all about standards and their enforcement and the need to ensure that an independent organisation with teeth was created to provide accountability.

The purpose was to ensure that the standards set would be applied consistently and on a national basis and, where necessary, action could be taken quickly and effectively to protect service users. It is fair to say HIQA has had an impact.

Early last Thursday, before the RTE investigation programme was broadcast, HIQA published its annual overview report on the regulation of designated centres for adults and children with disabilities. It pointed out that the initial inspections in 2014 led to the finding that residents living in many large congregated settings were not being adequately protected or kept safe and that institutionalised care practices, ongoing for years, had an adverse impact on the quality of life for residents. However, it is welcome that HIQA is now reporting that regulation has brought cultural change to the sector, steadily leading to improvements in the standard of care provided to residents. The report really highlights the need for further action to help support people with disabilities to live in a community environment. The report makes it clear that regulation has helped bring about steady improvements in the standard of care provided to people with disabilities, although it nonetheless highlights that further work is needed.

The recommendations made through the 2011 HSE report on congregated settings are yet to be implemented, with congregated settings or institutions with ten or more residents being replaced with supported placements in the community. It is estimated that approximately 3,000 people with a disability were living in congregated settings as of December 2014, at the time of the Áras Attracta programme's transmission. Sadly, not much has been achieved in moving people into community-based environments since. The HSE prioritised the transition of just 150 people from congregated settings in 2015 and yet it only managed to move 112 people last year, which is wholly inadequate and must be addressed. Regrettably, the Government has not made this a real priority in the programme for Government. It is unlikely to make any serious inroads as the reduction targeted is only in the region of 900, which represents just a third of the total figure. At this rate it will be 2031 before congregated settings come to an end. I urge the Minister of State to step up the campaign to bring the practice of outdated congregated settings to an end.

The Minister of State might agree that we cannot wait until 2031 for this to happen. I have praised HIQA and its achievements but I know some people feel it could be doing more for people with disabilities. In February 2015, Inclusion Ireland published The Distant Voice working paper, which analysed the HIQA inspection of 123 units providing residential services for over 700 people with disabilities across Ireland during 2014. Inclusion Ireland claimed that only 11% of residents across 50 reports were asked about communication needs, which is in stark contrast to the position in the UK, where persons with a disability are part of the inspection process. Is this something that can be provided for so we can ensure people with a disability are represented in the inspection process?

Fianna Fáil will support this Bill but if a further extension is required in 2018, there will be great disappointment and many questions will be asked. There is much we must do during this Dáil to improve the lives and opportunities of people with disabilities. That is a priority for me and my party. Before the end of the year I look forward in particular to the promised legislation for ratifying the UN convention on the rights of persons with disabilities. I welcome that the Minister of State with responsibility for the disability brief is at Cabinet, although Fianna Fáil wants to see a Department with disability inclusion specifically in the title.

Since my appointment as Fianna Fáil spokesman on disability, I have met representatives of a number of organisations working in the disability sector and all these groups have expressed their frustration at the slow pace of change in the area. They also pointed out there is a need for real political leadership to drive forward positive and inclusive reform of the disability sector in Ireland. People with disabilities must be prioritised in the upcoming budget. The Government must demonstrate its commitment to improving the lives of people living with a disability. We want an Ireland in which people with disabilities are given the resources they need to live their lives as full and equal citizens. It is our goal to realise this objective.

The impact of austerity policies on people with disabilities and their families has been devastating. I know the Minister of State knows that to be the case. The mobility allowance scheme was closed and educational supports, including resource teachers and special needs assistants, diminished. Medical cards have been targeted and the mainstream public services upon which those with disabilities disproportionately depend have been decimated. People with disabilities remain more than twice as likely to be unemployed compared with the typical population and just 15% of people with an intellectual disability are in employment. Sinn Féin has a vision for society in which all citizens, including those with disabilities, can play a full and independent role in all aspects of life, relying as far as possible on mainstream services for health, education and employment but with the support of tailored disability services where necessary.

The Health Act 2007 provided for the establishment of the Health Information and Quality Authority, known popularly as HIQA. It provided for the inspection and regulation of designated centres and the framework for registration of these designated centres. The introduction and establishment of such a body as HIQA was very positive. The measures in the Health (Amendment) Bill 2016 relate exclusively to residential centres for people with disabilities. I understand there are 1,000 residential centres for people with disabilities throughout the country and by June 2016, some 556 had been registered. HIQA estimates that over 350 centres will not be registered by the end of October this year.

We in Sinn Féin will vote in favour of the Health (Amendment) Bill 2016. We would of course have wished for all centres to have been registered by 31 October 2016, although we understand some of the complexities associated with such a process and we will therefore support the extension of time request. However, we have a number of concerns that we would like the Minister of State to address. I ask him to note these questions. We appreciate the major administrative task involved in the process but are other specific factors leading to such a delay? In 2015, HIQA reported to the Department of Health that it would not be possible to complete all registrations by the prospective timeline. Is it a question of resources? If so, why were more resources not directed to HIQA to allow it to complete the work within the initial agreed timeframe?

Following consultation with Inclusion Ireland, a body with which the Minister of State is well familiar, it has come to my attention that there is a list drawn up by the HSE of centres that it has already accepted will never meet the criteria required for registration. I ask the Minister of State to note this important fact. Will he comment on this? Given some of the controversies and scandals uncovered by the media and HIQA in recent times and not exclusively in disability residential settings, but across the social care sector, we have deep concerns that more than 400 residential settings have never been inspected.

We are aware that HIQA has returned to facilities that received unfavourable and damning reports many times, yet this large number of facilities remain uninspected, with the potential for service users to be at unrecorded and increased risk.

As recently as last week, it was reported that three residential centres for people with autism have now been taken over by the HSE at the direction of HIQA due to serious non-compliance. It is extremely concerning to learn of the significant failings found by HIQA relating to the care and welfare of 47 adult residents with autism living in three farm-based centres. These centres were inspected on a number of occasions over the past 18 months and particular concerns were raised regarding inadequate measures to ensure residents were protected from assault, ongoing risks to residents that were not being appropriately managed or responded to, poor governance and oversight leading to negative outcomes for residents, and poor management of staffing resources and inadequate staff training. Adults with special needs and their families require and deserve the highest standard of care. To hear of such non-compliance is extremely distressing. I am anxious that the extension of two years provided for in this Bill may mean that many other centres will continue to operate without being inspected for a considerable period, potentially leaving vulnerable people in facilities that are simply not at the standard required.

In the context of this Bill, we are of the strong belief that there is a great need to move the focus from congregated settings to the community, and not just to smaller settings but to full integration. Congregated settings are facilities where residents live in close proximity to each other and with an institutional mindset. They are inappropriate homes for anyone, particularly those with complex needs. The focus needs to shift from centre-based services to supported mainstream integration. The focus may be on empowering service users to take as full a role in life as possible. Resources are also needed to support families. This process of decongregation is happening but at a very slow pace. It must be accelerated and funding redistributed so that the main focus is on community rather than specialised settings.

I would welcome a response from the Minister of State to some of the points I have raised. In particular, I lay emphasis on the question of whether there is a HSE list of centres or an understanding that there are a number of centres that will never meet the criteria for registration. I ask again if this is the case. Does such a list exist? If it does, we have the alarming and incredible situation of residents who need care living in substandard care conditions with no prospect of the situation being appropriately addressed while those facilities remain in service.

I have a great respect and regard for HIQA and its work. It is appropriate and important to register that fact here this morning. I hope the issue of resourcing, to which I have referred, strikes a chord with the Minister of State. I believe it does and hope that in his position as Minister of State with responsibility for the disability sector he will help to ensure that HIQA is resourced and empowered to carry out all the important work it must do in the interests not only of those who cannot voice their own concerns and needs but of all citizens who depend on the State's health and care provision.

Glaoim anois ar an Teachta Maureen O'Sullivan.

I am sharing time with Deputy Catherine Connolly. How much time do we have?

I will not need a whole five minutes.

We have heard some really horrific stories and accounts of how people with disabilities, especially those with intellectual disabilities, have been treated in this country. We ally that with the stories of parents of children with disabilities and intellectual disabilities. I know the Minister of State, Deputy Finian McGrath, is one of those who has had to fight every step of the way to ensure their children will have the same rights and access as children who do not have a disability. I thought the stories from those in the industrial schools and the ladies in the Magdalen laundries were the worst we would hear about how we treat vulnerable people. However, we are hearing more heartbreaking, devastating and disturbing stories of what has been happening to those with an intellectual disability. Even more heartbreaking is that we know it continues today. However, I acknowledge those organisations, homes, front-line staff and intellectual disability nurses who have been instrumental in the giving of high-quality care. It is unfortunate that their positive work is being taken from by those who have abused their position.

It is vital that the registration process has an opportunity to be completed, but registration in itself is pointless unless there is follow-up. It is disappointing that the registration was not completed within the timeframe, which now needs to be extended by two years. HIQA mentioned various complexities with regard to quality and safety issues and the consequences if the deadline was not extended for the HSE. It stated that it would have to make alternative arrangements for the residents and that that would have major implications for them. We are speaking about vulnerable people in settings that are their homes. They have become used to these facilities and have visits from their families there, and those family members are satisfied with the standards. When people become settled and used to a routine, it can be difficult for them to handle change. I therefore support the provision of this extension, but it is disappointing that it is required. In the meantime, it is important to have a mechanism to address issues in unregistered homes. I know the Minister of State has made a commitment in this regard. However, we do not want to be hearing these stories for the first time in the media. We need to be more proactive so that the Government and the authorities know about them first.

The review by the National Disability Authority refers to the demands on service providers when applying for formal recognition. It mentions the time commitment involved in the paperwork. That is replicated in many voluntary organisations, which find it onerous, particularly voluntary management boards. I accept the need for regulation but I do not believe good paperwork necessarily equates to high-quality care. I have been involved in voluntary work for quite a long time and I know that organisations are overwhelmed by the extent of the bureaucracy and paperwork required. It is almost as if there is an agenda to try to remove as much of the voluntary effort as possible, something which would be very disappointing.

With regard to congregated facilities, the HIQA report notes that 70% of residents with a disability in designated centres are living in congregations of ten or more residents. They are the ones that are more likely to be non-compliant when the inspections take place, rather than the smaller residential institutions. We know that a smaller setting is better but we must be cognisant of the existence of centres with ten or more residents that have worked well and in which the residents are happy. The relationship between the staff and the resident, the standards in the home and the programmes available for people with intellectual disabilities are the most important aspects when looking at inspections of these homes.

Regrettably, after a certain age, people with intellectual disabilities can be left with nothing to do and nothing to stimulate them day by day. Various organisations have referred to the challenges for the disability sector, such as those around registration and inspection, but there are challenges for those who work with people with an intellectual disability too. I deal quite a bit with people with an intellectual disability and I know how time-consuming and challenging it is. The voice of those with a disability should be part of all the processes.

I have no hesitation in supporting this Bill. The Minister of State said it was a technical amendment to the 2007 Act with the sole purpose of extending the transitional period but the necessity of the amendment is certainly not technical in the lives of the people affected. I and everybody else throughout the country who watched the programme on Áras Attracta were rendered speechless. Being rendered speechless is not a good position for a legislator to be in. I had the experience of being present at the redress board relating to a number of institutions. It is an offence to talk about the details of that but I will talk in general terms. A charity in Galway which looked after people with a disability was before the redress board and the abuse we heard about was horrific. That was some time ago but what have we and the Government learned? I welcome the Minister of State's strong statements and his promise that he will take charge and not let this happen again under his watch. However, I have heard such speeches before from different Ministers. What will be different this time? It seems to me that no matter which Government is in power, it will make decisions based on resources and vulnerable people will suffer each time. We do not realise that we will use up scarce resources in following cases up with commissions of inquiry and reviews, Garda investigations and so on. I have returned to the theme of money on many occasions since I came into the Dáil four months ago and have spoken of how we end up spending more money in the long term in any event. In our new politics, will the Minister of State have an influence in pointing out that we will save money in the long term by valuing people who have a disability? We can learn from such people on a daily basis, given their strength in surviving with disabilities of which we know little. Our role is to give them the chance to thrive and to allocate funding to enable that to happen. Deputy Ó Caoláin asked about resources. Is the bottom line the fact that we are not allocating enough resources? If that is the problem, let us get it out into the open and discuss it in this Chamber as intelligent beings, so that we can make decisions.

We have dragged our heels for years on the UN Convention on the Rights of Persons with Disabilities and still have not ratified it. I am delighted that we have now given a commitment to do it before the end of the year but we have been forced to do it. It has not been a proactive policy by any Government and the move to give it priority has come from pressure applied prior to every election, local and general, by people who work on a voluntary basis. I support the amending legislation but would like the Minister of State to respond to the more general issues I have raised.

That concludes the debate.

I would have liked to have contributed.

Yesterday's order of the Dáil agreed that the debate would be for spokespersons only. The Deputy will have an opportunity on Committee Stage.

It might not be possible. In future, we should avoid situations like this because while spokespersons are very important, each Member elected to this House is also a spokesperson on behalf of the community that elected them.

I thank all Deputies who contributed to this debate. I give them a commitment to listen to their points of view and to respond to the issues they have raised. I absolutely share the deep concerns Deputies have expressed about the care by the State of vulnerable people with a disability. This Government is committed to the protection and safeguarding of children and adults with disabilities and I am determined that historical issues will be comprehensively examined and addressed. We have to change the mindset in Irish society and bring in real equality for all people with disabilities and that is part of my broader vision for the reform of services for people with disabilities.

A range of measures have been put in place in recent years to improve the care provided to the most vulnerable citizens and this will be progressed and improved. The system is clearly far from perfect but the fact that these issues are coming to light and are being investigated points to the fact that our oversight and regulation are getting better. My Department will receive a number of reports and reviews in the coming weeks which will shape and direct the way the disability sector is regulated.

I will now deal specifically with some of the issues raised by the Deputies. Deputy Margaret Murphy O'Mahony raised the issue of abuse and I agree that we have to ensure the protection of our citizens. She also raised the issue of congregated settings and I totally accept that we need to focus on them. However, the process is being supported this year by €20 million in capital funding from the Department of Health while assistance with transitional costs is being provided by the service reform fund to the tune of €45 million, with support from the Department of Health and Atlantic Philanthropies. The Deputy also said we needed more reform and more positivity in our health and disability services and some of the reports I will be receiving will deal with these issues. I hope there will be evidence of this reform come the autumn.

I appreciate the support of all Deputies on this issue. Deputy Ó Caoláin asked about resources. The answer to his question is "Yes". Disability services have been devastated for the past ten years. We need to up our game and to invest in services. He also asked about the inspection of services by HIQA, a very important question. All centres had been visited at least once by April 2016. The Deputy also raised the case of a number of centres of autism being taken over by the HSE in recent months. This shows that the system of regulation works and that there is a procedure in place to deal with centres which fail HIQA standards. There is no exception in the case of centres covered by section 69 of the 2007 Act. HIQA will continue to monitor and inspect all centres and will expect centres with the greatest challenges to meet the standards that have been prioritised for decongregation. The centres with the worst level of services, where physical space is often the issue, will be prioritised in the context of decongregated settings.

Deputy Ó Caoláin also mentioned mobility allowance. The Department of Health has prioritised the development of the transport support Bill in line with the commitment in the programme for partnership Government. The heads of Bill are in an advanced stage of development.

The Deputy mentioned the resource issue with regard to the Health Information and Quality Authority, HIQA. That is an issue we have to fix; it is a reality. I give a commitment that I will support HIQA on access and resources, because it is the guardian of citizens.

Deputy Maureen O'Sullivan raised the issue of abuse. She acknowledged that we must have strong, professional services but also acknowledged the good work that takes place. Many of us have experienced high quality services in the disability sector, but that is due to the staff - the right people doing the job in the right services. That issue continues to arise. I accept that Deputy O'Sullivan is disappointed about the extension, but I want to ensure that these services are up to standard. She also raised the quality of the day services. Yesterday, I met representatives of the National Disability Authority and they accepted that we had a very good discussion. We came up with a major programme for the end of December to examine the standards, because there is a variation of standards within day services. I am aware of many centres that have a structured day service with a high-quality timetable, and young adults with intellectual disabilities love the centres. Equally, in regard to other centres, I had a complaint recently where for one family it was costing the Health Service Executive €180,000 a year for a service that was appalling. The mother of that young person with an intellectual disability said that for half that amount of money she would get a better service. There is much inconsistency in the services, but we have high-quality day services.

I appreciate Deputy Catherine Connolly's support and I take her point. While I referred to a technical amendment to the 2007 Act, the wider view is that we have to ensure that respect for, equality in and reform of the services must be developed. The Deputy asked whether the Government had learned a very important lesson from what happened in the past. I hope to God we have, because I have become very frustrated with some of the situations I have come across recently. I agree with the Deputy on that. Deputy Connolly also made a strong point about high costs. I know we will probably have to go down the road of a commission of investigation, but it annoys me that we have to spend that money. Who will get the money? It will not be the services for adults with intellectual disabilities; it will be sections of the legal profession, but that is another debate. We might have to do that in this particular case. The Deputy made the strong point that if we invest in high-quality services it will save us money in the future. That is a reality and a vision we need to bring to the issue.

When it comes down to savings and resource issues, as I said to Deputy Ó Caoláin, these are important things that we have to change, and we must change the mindset also. Disability has to be brought to the top of the political agenda. I try to do that every day. It is very difficult at times but we do make progress. I hope we will make progress on these matters. Those were the issues and concerns raised.

Is there a list of centres that may never tick the boxes for registration?

As far as I know there is not, but I know from my experience in recent weeks in my new position in this Ministry that certain centres might not be up to standard in terms of their physical viability, although priority is being given to addressing that issue. It is more about dealing with outdated services, and my view is that they have been prioritised. I believe there are around 165 places on that particular list.

The purpose of the Bill is not to change any of the fundamentals of the HIQA inspection, regulation and registration regime, which is working very well. HIQA regulation has brought a cultural change to the sector and has steadily led to improvements in the standards of care provided by facilities. This Bill will simply extend the deadline by which residential centres must be registered in order to allow HIQA the necessary time to ensure that every centre is inspected fully and properly. HIQA will in no way be limited in the application of its powers and sanctions. I want to reassure parents, families and TDs interested in this section that it will retain its ability to inspect and, if necessary, cancel the registration of a residential centre that persistently fails to meet the required standards. I hope I have addressed the concerns expressed in the debate and that the Bill will receive broad support from all sides of the House.

Question put and agreed to.
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