JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 29 Jun 2010

Western Health Board Inquiry Report: Discussion (Resumed)

Chairman

Before we begin, I advise that by virtue section 17(2) (1) of the Defamation Act 2010 witnesses are protected by absolute privilege in respect of their evidence to this committee. If you are directed by the committee, however, to cease giving evidence in relation to a particular matter and you continue to do so, you are entitled thereafter only to a qualified privilege in respect of your evidence. You are directed that only evidence connected with the subject matter of these proceedings is to be given and you are asked to respect the parliamentary practice to the effect that, where possible, you should not criticise or make charges against any person or entity by name or in such as way as to make him, her or it identifiable. Members are also reminded of the longstanding parliamentary practice to the effect that members should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.

I welcome to the meeting the officials from the HSE and the Department of Health and Children. I ask Ms Ann Kennelly, national care group lead for disability services with the HSE, to proceed with her presentation, to be followed by Ms Bairbre Nic Aongusa, director of the office for disability and mental health in the Department. They are very welcome.

Ms Ann Kennelly

I currently hold the position of national lead for disability services. My submission to the committee follows on from a previous meeting with the Joint Committee on Health and Children on 24 June 2008 when my predecessor, Mr. Ger Reaney, outlined the background to the establishment of the inquiry by the Western Health Board into allegations of abuse in two facilities overseen by the Brothers of Charity in Galway, the subsequent publication of a report by Dr. Kevin McCoy and some of the actions taken by the HSE to coincide with completion of the report. Subsequently, in April 2009, the Department of Health and Children published the Hynes report, a review of the circumstances surrounding the lapse of time in completing the inquiry.

I will focus on actions taken subsequent to completion of the McCoy and Hynes reports with respect to the recommendations in both and will concentrate on the key pertinent points in my opening statement, which was circulated. The full submission includes implementation of the recommendations of the McCoy report on the Brothers of Charity services, findings in the Hynes report on actions taken by the HSE to address these findings and implementation of recommendations of the McCoy report in respect to all services for people with disabilities.

In December 2007 the HSE published the McCoy report on the investigation of allegations of abuse in certain facilities for people with intellectual disability under the direction of the Brothers of Charity in Galway. This followed a lengthy investigation which had been initiated by the Western Health Board in 1999. The report made a series of recommendations and the HSE immediately initiated an action plan to address these. With regard to the Brothers of Charity services in Galway and all other disability services managed by the agency, in counties Roscommon, Clare, Limerick, Cork, Kerry, Waterford and Tipperary, a programme of action based specifically on each recommendation from the McCoy report has been put in place. Regular meetings have been and will continue to be held with the Brothers of Charity services at national and local levels with regard to monitoring, on our behalf, the progress in implementing these recommendations.

This is a brief outline of the comprehensive progress achieved in the following specific areas within the Brothers of Charity services. This programme for implementing the recommendations in the McCoy report is monitored and tracked against a detailed and comprehensive template that relates to each recommendation. All clients are now assessed before being admitted to a service, using formal assessment instruments. The Brothers of Charity services have produced information leaflets and a website for service users and their families to explain what the service has to offer and how it will be provided. A person-centred plan is developed for each service user by a multidisciplinary team, in conjunction with a client and his or her family or carer prior to admission to a service. The majority of existing service users have a person-centred plan which is updated on an annual basis. All person-centred plans specify a review date. All service users receive induction, a tour of local services and introduction to staff and a key worker. Record systems across all Brothers of Charity services have been reviewed, to ensure that all relevant information is accessible to those who require it. Training has been provided in report writing and the maintenance of records. Records in all services are audited annually by a senior manager. A standardised report form for recording concerns and allegations of abuse has been introduced for use by all staff across all services nationally.

The Brothers of Charity have finalised two national governance documents for the protection and welfare of children and adults, respectively. The children's document has been reviewed by the HSE and recommendations from the HSE are currently being incorporated into the Brothers of Charity protection of vulnerable clients as part of mandatory training for all staff and included in the staff induction programmes for all new staff within a maximum of three months of commencing employment.

A strategic plan has been prepared for training of staff and service users in the areas of personal development, relationships and sexuality, based on the Brothers of Charity Guidelines produced in 2007. The training includes awareness for all staff, service users and families. A code of conduct has been developed and implemented for staff in all Brothers of Charity services and has been given to all staff. The complaints policy in Brothers of Charity services has been revised and is now compliant with the requirements of the Health Act 2004. Structures to facilitate adult service user advocacy have been put in place at local and national level.

Studio 3 training in dealing with service users who present with challenging behaviour, is part of mandatory training in areas where challenging behaviour is present. The Holy Family school now provides awareness training on child protection for all staff on an annual basis. All current staff have received training and training is ongoing for new staff. A code of conduct for teachers and other personnel in the Holy Family school, to safeguard the children attending the school, was approved by the board of management of the school in March 2008 and it is now part of the school's policies and procedures. Information on the school's child protection policies and procedures is made available to all parents and staff.

Work continues on planning for the transfer of clients from a number of inappropriate settings in the Brothers of Charity services and the fulfilment of a closure plan for Kilcornan Residential Centre in Galway. Some 32 individuals have relocated to community residences using existing resources, supplemented by €953,000 additional funding from the HSE.

There has been active and positive engagement by the Brothers of Charity at national and local level with the HSE on implementation of the recommendations of the McCoy report.

In April 2008, the Government announced that it had asked Mr. John Hynes to prepare a report into the delay in completion of the investigation of the Brothers of Charity facilities. Mr. Hynes forwarded his report to the Department of Health and Children and it was brought to Government in March 2009. The Hynes report states that the delays in completing the investigation into the Brothers of Charity facilities arose primarily from deficits in the terms of reference, the way they were devised, arrangements for the management of the inquiry process, the absence of a full range of skills and supports required by the inquiry and the loss of key members of the inquiry team.

The report recommends that the establishment of investigations and inquiries should include clarity of purpose from the outset with an agreed programme of work with realistic timescales and arrangements for the resourcing and management of the project together with arrangements for corrective action to deal with emerging issues. The report also recognises that, with the establishment of the HSE, steps were taken in August 2005 to bring the investigation to a speedy and satisfactory conclusion. It acknowledges the determination of HSE management to take a comprehensive approach which also involved establishing appropriate processes to deal with issues arising from the inquiry and notes that the Health Service Executive "managed to complete the process efficiently and without any unnecessary lapse of time".

Prior to its completion in August 2005, following the establishment of the HSE, immediate steps were taken to complete the inquiry in a comprehensive manner. Initially this was addressed through the provision of additional support for the chair of the inquiry. Subsequently, following the resignation of the chair, for personal reasons, Dr. Kevin McCoy was asked to prepare a report on the areas covered by the investigation. The HSE has reviewed the findings of the Hynes report and fully accepts the recommendations.

In addressing the findings of the Hynes report, I will set out a brief summary of the action and progress made by the HSE in strengthening the corporate governance arrangements with service providers, statutory and non-statutory, and the improvements in policies and procedures designed to further protect vulnerable adults and children who avail of services. Since the establishment of the initial investigation into the Brothers of Charity facilities in Galway, substantial changes have taken place in the way inquiries and investigations are established and managed in public health services.

In April 2009, the HSE management team approved the work of a HSE investigation process working group whose main purpose is to standardise, simplify and strengthen complaint and incident investigation processes in the HSE. It is planned that a draft single investigation process based on the feedback from the staff and service user consultation and engagement workshops will be available in summer 2010.

The HSE recently adopted a serious incident management policy and procedure, which will enable managers and clinicians to oversee and safely manage serious incidents arising from the delivery of all aspects of care and service provision. The policy and procedure outlines the steps that must be taken by each manager to identify and act on serious incidents that occur within their own service. It follows an extensive review of existing procedures and findings from investigations or serious incidents reviews already completed. The policy and procedure will be used in circumstances where a national or integrated response is required to manage the issue. It is also designed to allow the HSE as a whole organisation to learn from serious incidents, to prevent their recurrence.

The HSE has developed a draft procedure for Garda vetting of existing employees in the HSE, voluntary hospitals and agencies in the intellectual disability sector, working with children and-or vulnerable adults. The procedure outlines the steps that need to be taken to comply with the non-discretionary requirements set out in relevant legislation and by regulatory bodies. It is aimed at ensuring a fair, equitable and consistent approach to vetting and assessment of employees in fulfilment of these obligations. These procedures which have been put in place for the establishment and management of inquiries and investigations address all of the issues raised in the Hynes report.

Significant progress has been made in the development of standards and guidelines for best practice in residential services for people with intellectual disabilities. HIQA has developed and published two sets of standards — one for adults and one for children — which will impact on the delivery of residential care within disabilities by the HSE by the end of 2010. Ms Bairbre Nic Aongusa will refer to this in greater detail in her submission. Prior to this and in the absence of national standards for residential services for persons with disability, the HSE prepared guidance documents in respect of children and adult services which outline the quality of care which should be provided in these services. These documents informed the HSE input into the development of the HIQA standards and provided a level of assurance and direction in respect of quality of services in advance of the HIQA standards being published. It was agreed in 2009 by the Department of Health and Children, the HSE and HIQA that progressive non-statutory implementation of the adult standards should commence.

Action 40 of the Ryan implementation plan commits to commencing the Health Act 2007 to allow the independent registration and inspection of all residential centres and respite services for children with a disability by December 2010. In respect of standards for residential services for adults with disabilities, given the current economic situation, full statutory implementation of the standards, includes regulation and inspection. The provision of significant resources required for this presents significant challenges at this time. However, the Department of Health and Children, the HSE and HIQA have agreed that the standards will be implemented, initially on a non statutory basis and that they will become the benchmark against which the HSE and non-statutory providers assess their facilities. The HIQA standards will also be included in the service level agreements as part of the quality standards which need to be adhered to by all service providers. In preparing for implementation of the standards, work has commenced to prepare a validated data set of all locations nationwide where residential disability services are provided. The standards have been circulated and a programme of awareness training is commencing.

Over the past three years, there have been key service reviews and strategies to move disability service provision locations away from institutional segregated settings and into the community. In particular two comprehensive reviews of day and residential services nationally have been carried out by the HSE. Again Ms Bairbre Nic Aongusa will make further reference to these in her submission. The resulting recommendations from these reviews will guide the development of a national plan and change programme for transferring people with disabilities from segregated settings to the community. Pending adoption of both reports as policy, and in the context of the current value for money and policy review currently under way, the implementation plans will be developed in all four HSE regions involving the relevant service providers.

The HSE is committed to undertaking an audit of incidents of abuse in residential and day services for people with intellectual disability. Working with the National Federation of Voluntary Bodies, we have commenced the process of a national review and audit of client protection issues within the statutory and non-statutory intellectual disability services. Phase one of the project is to develop a questionnaire exploring demographics of service organisations, review of their policies, procedures, and training relevant to client protection. It will also include a review of the numbers of allegations of abuse at any stage of the process in 2008. The phase one questionnaire is ready for dissemination in the coming weeks and it is anticipated that the collection of the questionnaire will be completed by October 2010. The research for phase one has been granted ethical approval by the RCPI. The statutory and voluntary organisations within the National Federation of Voluntary Bodies have been alerted to the imminent delivery of the questionnaire.

Phase two will involve a more in-depth on-site audit of a targeted sample of organisations, involving interviews with key individuals, for example, chief executive officers, designated persons and front line staff members. It will also involve an audit of relevant records. The output of phases one and two should result in a final report, which incorporates a literature review of best practice, benchmarked against areas such as staff training-knowledge and skills, management of allegations and implementation of policies and procedures.

The HSE is committed to providing safe and quality care and has put in place a range of standards, guidelines and procedures to protect all service users, with a particular focus on children and vulnerable adults from potential abuse or harm by service providers. The service level agreements that are required to be signed by all non-statutory providers ensures that every service provider is required to have appropriate mechanisms in place to assess quality and standards for the delivery of all services. This agreement requires all service providers to comply with relevant legislation, statutory regulations, codes of practice and agreed guidance documents in relation to the standards associated with the service in question.

While child protection is covered by legislation, this does not apply to adults who may by reason of disability, illness or age be vulnerable to abuse of one form or another. The care safe standards and guidelines were developed by the HSE to ensure the needs of these service users are recognised and addressed. These standards and guidelines address the risk of abuse or harm to all service users but particularly for defined vulnerable persons while in receipt of health care services from HSE service providers. The standards and guidelines cover the following areas: protection of service users; human resources and service providers conduct; consent; providing services, clinical interventions and treatments; medication, restraint and managing challenging situations; and wills and associated financial management issues.

In agreeing these standards the HSE has reviewed all relevant current HSE policies, procedures and good practice standards and guidelines. It is a requirement that all managers within the health service ensure that service providers are aware of the standards and guidelines outlined in this document.

A good faith reporting policy is developed that sets out how all employees are encouraged to raise genuine concerns about possible improprieties in the conduct of the HSE's business, whether in matters of financial reporting or other malpractices, at the earliest opportunity and in an appropriate way. The HSE integrated risk management policy document sets out the HSE's governance structure for the identification, measurement, assessment and management of risk. It also sets out how this function assists the HSE achieve its objectives through the adoption of a systematic, comprehensive and integrated approach to risk management.

The systems and processes outlined above constitute a summary of the pertinent areas of work relative to today's discussion. In the context of the wider HSE system of service provision to people with intellectual disabilities, progress is being made by the HSE in developing a strong quality and risk management framework that guarantees clear accountability between any agency or organisation providing services on behalf of the State for people with disabilities and the HSE. I will be happy to elaborate further, as required.

Vice Chairman

I thank Ms Kennelly. I now invite Ms Bairbre Nic Aongusa to make a presentation.

Ms Bairbre Nic Aongusa

I am the director in the Office for Disability and Mental Health at the Department of Health and Children. My submission today is intended to complement the submission from the HSE and will focus on the recommendations in the McCoy report relating to the Department, and the progress that has been made in those areas.

The Office for Disability and Mental Health was established in 2008 to support the Minister of State with responsibility for disability and mental health in exercising his responsibilities across four Departments: Health and Children, Education and Science, Enterprise, Trade and Employment and Justice, Equality and Law Reform.

The Government's decision to establish the Office for Disability and Mental Health was a recognition of the need to improve co-ordination and communication across different Departments and agencies in their delivery of services to this client group. The new office brings together responsibility for a range of different policy areas and State services which directly impact on the lives of people with a disability and people with mental health difficulties. Its aim is to bring about improvements in the manner in which services respond to the needs of people with disabilities and mental health difficulties and to develop person-centred services, focusing on the holistic needs of clients and service users and actively involving them in their own care.

The work of the Office for Disability and Mental Health is informed at all times by the objectives of the national disability strategy and the vision as expressed in the national partnership agreement, Towards 2016, that "every person with a disability would be supported to enable them, as far as possible, to lead full and independent lives, to participate in work and in society and to maximise their potential". As part of the Department of Health and Children, the Office for Disability and Mental Health also has responsibility for policy formulation in relation to disability services in the health sector. In addition, it determines the overall provision of funding to the HSE for the delivery of disability services, through the annual service planning process, while responsibility for operational matters rests with the HSE.

Ms Kennelly has dealt comprehensively with the many recommendations in the McCoy report relating to the HSE and has also referred in her submission to a small number of recommendations relevant to the Department. I do not propose to go over the same ground again, but I would like to highlight three key issues touched on in the McCoy report which are of strategic importance from the Department's perspective. These are the implementation of national standards for residential services for people with disabilities; the future of congregated or institutional settings as a model of provision for residential care in the disability sector; and the need for greater transparency and accountability in the allocation of resources in the disability sector in order to ensure that services are delivered in the most efficient and effective way possible.

In regard to the development of quality assurance and standards, the McCoy report recommended that HIQA, the agency with responsibility for the development and monitoring of standards for people with a disability, should put in place appropriate processes, best practice standards and associated monitoring and inspection arrangements as a matter of urgency.

With regard to residential services for adults, HIQA published its National Quality Standards: Residential Services for People with Disabilities in May 2009. These standards provide a national framework for quality, safe services for adults with disabilities in residential settings. As has been indicated, the current economic situation has necessitated a deferral of the move to full statutory implementation of the standards, including regulation and inspection at this time.

However, notwithstanding the difficulties of immediate statutory implementation, the Department of Health and Children, the HSE and HIQA have agreed that progressive non-statutory implementation of the standards should commence and become the benchmark against which the HSE assesses both its own directly operated facilities and other facilities that the HSE funds.

The Office for Disability and Mental Health is liaising with the HSE in terms of implementing the standards on a progressive non-statutory basis within existing resources. Within a broader context, the Department of Health and Children is also engaged in ongoing discussions with HIQA in respect of the resources that would be required to implement a mandatory scheme of registration and inspection of residential services for people with disabilities. In addition, arising from the Ryan Commission report and a renewed focus on the needs of vulnerable persons in residential care, the Minister for Health and Children will bring proposals to Government in the near future with regard to the protection of vulnerable adults with disabilities who are currently in institutional care.

Children with disabilities in generic residential centres under the Child Care Act 1991 are covered by the standards and inspection regimes already applying to those centres. However, a further 150 centres approximately offer residential or respite care to approximately 300 children with disabilities. Children who reside in these centres are not in the care of the State, although they are cared for by the State. The majority of these centres are run by voluntary organisations funded by the HSE and are excluded from inspection under the Child Care Act 1991. In regard to the children with disabilities in these residential centres, the Ryan commission report recommended that "all services for children should be subject to regular inspections in respect of all aspects of their care".

An implementation plan for the recommendations of the Ryan commission was submitted to Government by the Minister with responsibility for children and youth affairs, which included proposals to implement, in full, all the recommendations of the commission. The implementation plan contains a commitment that the Health Act 2007 will be commenced to allow the independent registration and inspection of all residential centres and respite services for children with a disability.

A standards advisory group led by HIQA is in the process of developing standards for residential services for all children, including children with disabilities. It is expected that HIQA will finalise and publish these standards later this year.

The second issue I raised was the future model for the provision of residential services to people with disabilities. Recommendation 10.7.1 of the McCoy report said that residential care in campus or congregated centres should be kept to an absolute minimum of provision and that the dominant focus should be development of comprehensive family support and tailored packages to maintain children and adults within their families and within the community. In addition, the McCoy report recommended that a fundamental review of campus style residential settings should be undertaken by the HSE in partnership with the providers of all such services, and that all stakeholders should consider the development of a specific investment programme which would resource the transfer of the vast majority of such persons from campus style settings to community-based settings.

Arising from these recommendations, a working group, chaired by the HSE, with representation from service providers, self advocates, umbrella organisations for people with disabilities, parent and user representatives, the Department of Health and Children and the National Disability Authority, has been preparing a review of the needs of clients currently accommodated in institutions and congregated settings. More than 4,000 people with disabilities currently reside in congregated settings and more than 2,000 nurses are employed in this area.

I understand the HSE working group is at an advanced stage in its work and that a final draft of the review is being prepared. Among the issues under consideration by the group is the setting up of a number of demonstration sites to validate the main recommendations on the proposed new model of service delivery, which centres on providing individualised supports to enable independent living in the community.

The Department fully supports emerging initiatives of this kind. To assist service providers in exploring new models of service provision, the Minister of State with responsibility for disability issues and mental health, Deputy John Moloney, announced in December 2009 the allocation of a €3 million innovation fund for disability and mental health services to support the transition from institutional to person-centred models of care. This funding has been allocated to Genio, a non-profit organisation which supports self-determination, inclusion and equality for disadvantaged and vulnerable people. Genio has established a fund with support from The Atlantic Philanthropies to support the transition from traditional, expensive group-based services to more effective individualised, person-centred supports. This allocation of €3 million is a reflection of the important partnership which has developed in recent years between Government and philanthropy in driving the reform of our disability and mental health services.

In addition to managing the fund, Genio will provide learning opportunities for those interested in leading and managing change and will support people with disabilities and mental health problems to advocate for services that meet their needs. The service reforms which will be facilitated by this fund are fully in line with the objectives of Government policy, as set out in A Vision for Change, and with the objectives of the national disability strategy.

It is also clear at this stage that any meaningful change to reduce the numbers of persons in institutional and congregated settings will require a comprehensive review of the allocation of existing resources in the disability sector along with the reconfiguration of staff and the skill mix of staff supports required for the proper implementation of new service delivery models. Close collaboration with other public bodies providing services for persons with disabilities will also be required.

Turning to the review of efficiency and effectiveness of disability services, very significant additional resources were provided for services and supports in the area of disability over the past decade under successive multi-annual investment programmes. For example, upwards of €900 million was provided under the programme for the period 2006 to 2009, which was the third multi-annual investment programme. Overall, approximately €1.6 billion is spent annually by the health services on disability programmes, including residential, day care, respite, assessments and rehabilitation services. While the Government recognises that funding should be provided to meet ongoing needs, it also recognises that the continued delivery of services is vitally dependent on the most efficient and effective use of available resources, to the maximum benefit of service users in the first instance.

With this in mind, the Minister of State with responsibility for disability issues and mental health, Deputy John Moloney, announced last September the establishment of a steering group to oversee a review of the efficiency and effectiveness of disability services in Ireland. The review is part of the Government's overall value for money and policy review programme and it will assess how well structures and services for people with disabilities meet their objectives and how the future planing and development of services in this area can be supported. The steering group for this review has an independent chairperson, Mr. Laurence Crowley, and two other independent members as well as members drawn from the disability sector, the Department of Health and Children, the Department of Finance and the Health Service Executive. The work is being carried out by a project team, which is assessing the efficiency and effectiveness of current financial provisions to the sector, and a policy expert review group, which is considering the most appropriate way to deliver disability services in the future, including alternative models of funding and budgets for services to enable people with a disability to participate in the social and economic life of their community. It is expected that the review, which is well under way, will provide an evidence-based approach to the future provision and funding of services by pointing to ways of achieving better outcomes for people with disabilities.

A structured consultation process with service users and service providers is an integral part of this review. A public consultation process was undertaken in late 2009 and attracted almost 200 responses from a wide variety of respondents, including service users, family members and service providers. The National Disability Authority also conducted focus group consultations with people with disabilities, their families, advocates and front line service providers on behalf of the group to ascertain the attitudes of people with disabilities and their families.

The policy expert reference group is nearing completion of its report to the steering group on a new policy framework for the proposition of disability services and has taken cognisance of the findings of the public consultation process in developing this policy framework. It is expected that substantial progress on completing the overall review will have been made by the end of this year.

I refer to the second report being considered by the committee today, namely, the Hynes report. In view of concerns raised in the media and elsewhere following publication of the McCoy report, it was agreed by Government that an inquiry should be held into the "circumstances surrounding the delay in bringing the inquiry to completion". Mr. John Hynes, a former Secretary General of the Department of Social and Family Affairs, was appointed by the Minister to carry out the review. The findings of the Hynes report, which have already been outlined in Ms Kennelly's statement, were accepted in full by the Department of Health and Children. They provide important guidelines for the Department and the HSE for the future conduct of any such inquiries.

I would assure the members of the committee of the determination of the Department and the Office for Disability and Mental Health to learn the lessons that have emerged from the McCoy and Hynes reports. We intend to build on the progress made to date to ensure that services for people with disabilities meet the needs of the service users, are provided as effectively and efficiently as possible and to the highest possible standards in line with the objectives of national policy.

I will be happy to answer any questions or provide clarification the members may require.

Vice Chairman

I thank Ms Nic Aongusa for her presentation. I call Deputy James Reilly.

Deputy James Reilly

I welcome the representatives of the HSE committee to the Oireachtas committee. I am aware my colleague, Deputy Shatter, has many questions to ask concerning the McCoy report and issues relating to who was interviewed and so on. I will direct a few questions to Ms Kennelly on her statement on the reports, page 4 of which states: "the Complaints Policy in [the] Brothers of Charity ... has been revised and is now compliant with the requirements of the Health Act". Who is the complaints officer and who employs that officer, bearing in mind that those who make a complaint surely have a right to have an independent person deal with his or her complaint?

Ms Kennelly stated that structures to facilitate adult service user advocacy have been put in place. Can she explain to the committee precisely what they are? She also stated that there is a "code of conduct for teachers and other personnel in the Holy Family school, to safeguard", etc. What happens if that code of conduct is not adhered to? Who adjudicates on that?

Ms Kennelly stated that a person-centred plan is developed for each service user by a multidisciplinary team in conjunction with the client and his or her family or carer prior to admission to a service and that the majority of existing service users have a person-centred plan, PCP. Why do they not all have that? Why only a majority? Could she tell the committee precisely the figures? How many have and how many do not have a person-centred plan?

Ms Kennelly stated: "Record systems across all Brothers of Charity services have been reviewed, to ensure that all relevant information is accessible to those who require it ... Records in all services are audited annually by a senior manager." Will those records be available to HIQA? Ms Kennelly went on to state: "The standards have been circulated and a programme of awareness training is commencing." When will that happen?

One of the problems I have with all this is that, again, we are presented with plans for the future instead of action that should be taken now. My main concern, notwithstanding the tone of the report where it is espoused by the HSE that it applauds those who blow the whistle, is that there is no whistleblower legislation and it has not been the experience of those in the past who have blown the whistle that they have been applauded or lauded, rather quite the contrary.

I apologise that I must leave. In finishing, I point out that there is still no independent inspectorate and this is unacceptable. For some of the most vulnerable in society, it is the HSE inspecting the HSE, or the Brothers of Charity, who are agents of the HSE. I deplore the lack of the legislation required to safeguard whistleblowers.

Deputy Kathleen Lynch

I thank the delegation for the two detailed presentations. It is clear from reading the McCoy report how the delays occurred. One can never justify a delay of ten years in total to complete, but it is obvious that the terms of reference were a major problem, as was the lack of appropriate staff and no one really having any idea as to who they could employ and what they needed to employ. It comes back to not being able to question the terms of reference. I am glad to say that will not happen again, even though I am reluctant to do so. Nevertheless, I hope it will never happen again because it is obvious where the delay occurred.

We had Ms Margaret Kennedy before the committee last year to discuss the Brothers of Charity in Galway. She was a most impressive woman and seemed driven by the need for an inquiry to take place into suspected abuse within the Brothers of Charity in Galway. The McCoy report states that the complexity of interviewing not only previous service users but also those who were using the service there and then and everyone connected was a significant difficulty. How many persons were interviewed and was an advocate employed to work with those with an intellectual disability ever involved? Having heard the second presentation, it seems that when one is dealing with abuse of someone with an intellectual disability, it will take longer and one must take a little extra time and make an additional effort to find out exactly what happened. That comes with the territory. It should be known from the outset that that would happen. Reading part of the McCoy report, it seemed that those involved in the original report appear to have been overwhelmed by the task and as a result, chose not to come to any conclusions. There was not sufficient capacity to find anyone culpable. That type of response is not good enough. I am not suggesting for one minute that we will go back over the whole matter again, but there should be some way of going back and asking who was interviewed, how they were interviewed, what they stated at the time and what we can garner from that. I would hate the notion to go abroad that only because one was dealing with persons with an intellectual disability at all levels, somehow it was not possible to garner the information we needed to hold persons accountable. We must take a serious look at that.

Are any of the care givers who were involved at that time still involved? I assume the majority of those involved were persons who gave very good care and were not accused in any way, but where are those against whom allegations were made? Are they still within the system? Are they still in Galway? I am not looking to identify anyone, but that is important.

The report shows there were not enough staff. On having to review all the correspondence single-handedly and then to start to respond to issues as they arose, surely the terms of reference could have been adjusted at some stage when it became evident that the job was simply too big for those involved. What happened there?

The Hynes report, on page 14, paragraph 5.4, states:

There were clear differences of view in relation to the resources provided to the Inquiry. The Regional Manager pointed out that the team, when set up, was fully funded to deliver a report within a reasonable timescale and it was never envisaged that the process would take as long as it did. As the process unfolded he found himself responding to issues as they emerged and seeking to respond as the Chair identified emerging needs.

We are not talking about ancient history here. The report was delivered in 2009. Surely someone saw that additional staff, and perhaps additional specialised staff were needed.

Was everyone interviewed? Were those who made allegations taken seriously? What happened in respect of those? Our fingers are crossed that this will never happen again, but there are still the fundamental questions. Are the persons against whom the allegations were made still within the system?

Deputy Margaret Conlon

I, too, welcome the representatives from the HSE and the Department. We are dealing with vulnerable persons who placed their trust in a system and the system failed them. Moving on from that and learning the lessons that we are learned, we must ensure there will not be a repeat of this.

I listened to all that was said by both speakers, in particular the first speaker. Ms Kennelly informed the committee with regard to what has and is being done and outlined the reviews that have been carried out, the strategies that have been put in place and the implementation plans that have been drawn up. She also referred to different policies and procedures. In 2007, I left a school at which many of the policies, etc., to which she referred were in place. It was necessary for them to be in place because they are statutory requirements. The HSE appears to be some distance away from getting its house in order and putting policies such as those to which I refer in place. There appear to be major delays in respect of carrying out this type of work. If I am wrong in this regard, I stand to be corrected.

I share Deputy Reilly's concern with regard to why existing service users do not all have person-centred plans. Why does the HSE differentiate between people in this regard? Surely it should be a requirement that every service user should have a person-centred plan. Will our guests clarify the position in respect of this matter?

I have massive regard for HIQA, which does a wonderful job and which has made major changes in the context of ensuring higher standards. Ms Nic Aongusa stated: "The majority of these centres are run by voluntary organisations funded by the HSE and are excluded from inspection under the Child Care Act 1991." How many such centres are run by these organisations? Ms Nic Aongusa also stated: "the Ryan commission report recommended that "all services for children should be subject to regular inspections in respect of all aspects of their care"." Has a definite timeframe been laid down in respect of when this should happen? If we have learned from the various reports that were compiled in recent years, it is that there can never again be a situation such as that which existed in the past when major questions arose with regard to the care of children.

Reference was also made to removing people from institutional-congregational care and placing them in community-centred environments. I would certainly be in favour of such a development, provided the necessary staffing and other resources were available. Our guests also referred to a review of staffing and the skills mix and stated that there is a need for collaboration. There is also a need for clear consultation which the families of service users. For them, this represents a major change in their lives. People are concerned with regard to what might happen if their relatives are moved from institutional to community settings. This all relates to a fear of the unknown and we need to be sure that the necessary resources and staff are in place in order to ensure that service users receive high-quality care.

Close collaboration with other public bodies is extremely important. However, it is also vital that consultation and communication with service users and their families should take place in an open and transparent manner. Patients must come first because it is they who require care in the first instance. I have dealt with those who provide other services on behalf of the HSE and I am aware that one can encounter either a lack of information or else one is treated to quite a degree of misinformation. If the HSE is considering moving to a different setting, it cannot afford to allow any gaps to exist in respect of the matter to which I have just referred.

Deputy Alan Shatter

I apologise for my late arrival. Fortunately, members were presented with copies of the opening statement and I had an opportunity to read it and familiarise myself with its contents before coming to the meeting.

I am concerned with regard to a number of matters. We appear to be going around in ever-decreasing circles and I have the feeling that I am stuck in the film "Groundhog Day" at this stage. The committee examined the McCoy report in great detail some 18 months ago. Said report detailed what appeared to be the complete mess the former health board — this was carried over into the HSE — made with regard to the inquiry that was conducted. The committee postponed making any decision with regard to what should result from its hearing on the McCoy report until the Hynes report had been completed. The latter was completed some considerable time ago and we are now having this meeting at which representatives of the HSE — they were also present at our original meeting — and the Department of Health and Children are present. I wish to deal with what I understood to be the purpose of this committee examining these issues initially and then deal with the position at which we have arrived today.

The initial purpose of considering the McCoy report — as I had understood it and as originally discussed by the committee — was to facilitate the committee in determining whether there had been a full, adequate and proper inquiry into allegations of physical and sexual abuse of children with disabilities who were resident in institutions operated by the Brothers of Charity. We discovered that the entire membership of the committee originally appointed to conduct the inquiry had resigned many years prior to the publication of the McCoy report. Within 18 months, the entire committee, with the exception of the chairperson, had gone. The chairperson hung on until 2005 or so, when she eventually left. At that point, the HSE drafted in Dr. McCoy.

I wish to restate what I said when Dr. McCoy was present before the committee. That is, I am not in any way critical of Dr. McCoy who was handed a poisoned chalice and charged with clearing up the mess created by the former health board. The HSE recognised, in the context of public pressure exerted upon it, that said mess needed to be addressed. Allegations of a serious nature that were made in respect of the abuse of persons with disabilities were not properly investigated.

Dr. McCoy very fairly informed the committee that the only information available to him was the paperwork on the files he inherited and that he had attempted to craft a report out of that paperwork. What the latter showed was that 21 persons who had made allegations that physical and sexual abuse occurred in institutions operated by the Brothers of Charity had been interviewed by the original committee established in 1999. It seems incredible that the original inquiry was launched 11 years ago. Dr. McCoy also pointed out that he could only work with the material available to him.

The Hynes report was commissioned as a result of the furore that erupted on foot of the McCoy report and the failure to consider and examine the modalities — to use a very modern word — of how we came to be in this situation, the structure relating to what occurred and the reason for the delay. The one thing we knew when we met Dr. McCoy was that while the group that was initially involved in drawing up what eventually became the McCoy report interviewed 21 persons who made allegations of abuse, some 133 persons suffering with disabilities who were associated with the institutions to which I refer had, as far as I am aware, at that time sought and obtained compensation from the Residential Institutions Redress Board.

At that point, the committee had come to know that there was a massive dysfunction with regard to the extent of the investigation conducted. This was because it emerged that far more people had suffered abuse than had ever been approached. It came to light that the methodology involved had not been to contact the people who have been in these institutions and whose names and addresses were known but rather to place advertisements in newspapers. The people to whom I refer or their families were supposed to have read these advertisements. That is why there were only 21 complainants.

The Hynes report fairly, accurately and succinctly details the catastrophic and dysfunctional nature of the original inquiry. In his conclusions, he says the difficulties that arose were contributed to by the following factors:

(a) the unsatisfactory nature of the terms of reference themselves and the way they were devised;

(b) the lack of adequate arrangements both within the Inquiry team and within the WHB for the management of the Inquiry process;

(c) the fact that the Inquiry did not, from the start, have the full range of skills and supports required; and

(d) the loss of key members of the Inquiry Team.

Other factors identified were the failure to provide adequate personnel from the start or replacement staff when team members left and those asked to conduct the inquiry had minimal training on how to go about doing so and had little experience. That applied all the way up to the chairperson.

The report states in page 8:

The Inquiry was to investigate allegations of abuse and this was seen as requiring making judgements and drawing conclusions about the veracity of the allegations and the responses to those allegations. Ultimately, however, it proved impossible, in the context of finalising the Report of the Inquiry, to draw conclusions as to individual culpability. The complexities involved in drawing such conclusions, particularly in an area of such sensitivity, undoubtedly had an impact on the delay which occurred.

Not too long ago, I was informed by the HSE and the Minister for Health and Children that the sensitivities associated with children in care were such that the information could not be made public. This is the same excuse for a grossly inadequate inquiry into scandalous allegations that young people in the care of the State or the Brothers of Charity, who are funded by the State, suffered abuse.

The report states in page 10:

A notable feature of the investigation process was that the Chair herself was not directly involved and the interviews were carried out by two teams made up from the other members of the team. In relation to the decision to operate in this way the Chair stated that this decision was made prior to the start of the Inquiry and that she was not consulted as to the appropriateness or otherwise of this decision.

What we had in the original inquiry, as revealed by Mr. Hynes, was a number of people appointed as a team, none of whom had any training on how to conduct inquiries, with a chairman who was told by the Western Health Board that she was not to participate in meetings with people alleging abuse but was to second two of her team to conduct such meetings. Within 18 months, the entire team had disappeared off the map and the chairperson was left.

I listened with great interest to the first presentation. Some of what was said was well worth saying and some referred to the ongoing, long drawn-out, promised HSE wish list of reform that I have heard in the child care area since 2005, which is still continuing and which the Minister of State with responsibility for children says will be completely and utterly unreliable. I am sorry, as he should be present, and I have no wish to make life difficult for a non-elected public servant. We went through the issues that my colleague, Deputy Reilly, raised as unsatisfactory and I will come back to one of them. We then had the presentation of the Department of Health and Children regarding the McCoy report, which mentioned the Hynes report in one paragraph, stating:

In view of the concerns raised in the media and elsewhere following the publication of the McCoy report, it was agreed by Government that an inquiry should be held into the "circumstances surrounding the delay in bringing the inquiry to completion". Mr. John Hynes, a former Secretary General of the Department of Social and Family Affairs, was appointed ... The findings of the Hynes report, which have already been outlined in Ms Kennelly's statement [which was the first statement] were accepted in full by the Department of Health and Children. They provide important guidelines for the Department and the HSE for the future conduct of ... such inquiries.

To use the politically correct phraseology, we have another learning curve and learning process but it is all full of damn learning, which does not seem to change a damn thing.

However, the message does not seem to have landed in the Department or in the HSE that we now have the Hynes report — it has been in existence for in excess of 12 months — which, without any doubt, confirms there was an utter failure to conduct an acceptable inquiry into the abuse of those suffering disability in Brothers of Charity institutions. This is not about learning how we do it in the future for people who in the future allege abuse. The message we need to address and on which the committee needs to make a decision — I am only a guest at this meeting because this is an issue I feel strongly about — is, now it is known the inquiry was inadequate, the terms of reference were defective, the methodology was inappropriate, there was a lack of back-up staff, and an insufficient number of individuals who alleged abuse were given an opportunity to be interviewed or consulted, is whether we have a real, proper and appropriate inquiry into the abuse of young people suffering from disability in institutions run by the Brothers of Charity. Are they not entitled to the same type of inquiry as that conducted by the Ryan and Murphy commissions into the specifics of what occurred to them or is it because they suffer disability, they cannot march on the streets and they have no political clout that they are people of lesser value whose abuse does deserve proper investigation and consideration? That is the issue the committee must especially address arising out of this report.

I am astonished that in the two presentations made, apart from talking about learning for the future, a wish list of measures the HSE hopes to implements and the support for all of them in the Department of Health and Children, there was not a single sentence acknowledging that there was not a proper inquiry and what we should now do. There is an issue whether it is practical now to conduct such an inquiry. That is a serious issue which should be addressed. Can we identify those who were abused? If it is correct that 133 former residents of Brothers of Charity institutions suffering from disability successfully claimed compensation through the Residential Institutions Redress Board, it is possible, because each of them can be written to, to put together a proper inquiry team and for an inquiry to be properly conducted and their stories told. What is so sensitive needs to be addressed and properly investigated and that has not happened yet.

I apologise for speaking at greater length than members of the committee but it seems to me the presentations made have completely missed the purpose of the meeting. We must ensure we do things correctly in the future but we have to look at the failure that occurred and what needs to be done to correct it.

In the context of the presentations made, there was a reference to the national quality standards for residential services for people with disabilities providing a national framework, which when they were initially envisaged were to be given full statutory force. We are now told that because of the economic climate, they cannot be given statutory force. I do not understand this. Either they are specific standards to be applied or they are not. They cannot be applied in a bit or half applied. If they are to be applied, I do not understand why they cannot be given statutory force. If they are not to be applied, could we leave aside the bureaucratic gobbledygook, simply say that these are the desirable standards and we do not have the capacity to ensure their implementation, and not engage in waffle about guidelines? We have had child protection guidelines since 1999 and we know the HSE up to this very day has utterly failed to comply with them. Why, in the name of God, should anyone believe the executive will apply these guidelines? The Minister with responsibility for children finally recognised, after publication of the Ryan commission report, the need to make the child protection guidelines statutory. We will not have proper standards in the area of disability nor will those proper standards be policed until such time as the standards are statutory. Therefore, let us stop making a pretence that there is an alternative, some halfway house, which will guarantee their implementation but which is not statutory. That is just a cover-up that says we know the standards are not being met currently, we do not have the capacity to meet them, but we will make a pretence over the next few years that we will meet them. If it was not a pretence, they could be statutory. The only reason for not making them statutory is that we would then be breaking the law by not complying with them. We must get real about this, not just within the HSE but within the Department of Health and Children.

Chairman

Let me make it clear for the record that on convening this meeting we requested that the officials from the Department of Health and Children and the HSE who are appearing before us would brief us on what had actually happened with regard to how the recommendations of the Hynes and McCoy reports had been implemented. That was the brief we gave them for today's meeting.

Deputy Alan Shatter

We started on this road.

Chairman

I apologise for having to leave the meeting for a period, but I assume the officials followed the brief given to them by the committee. In the context of Deputy Shatter's comment that we should address the Minister, we may choose to do that. However, at this point, we simply asked the HSE and the Department of Health and Children to appear before us. If committee members wish the Minister and Minister of State to come in and discuss the matters, we can arrange that. However, it is not the Ministers' fault or the fault of their officials that they are not here. It is because we did not decide to invite them.

Deputy Alan Shatter

When Margaret Kennedy attended this committee, she told us there had been a grossly inadequate inquiry and pleaded for a proper inquiry. That was what stimulated the original meetings, but we seem to have gone somewhat off course in the context of the approach being taken. That is an issue I believe the committee needs to address.

Deputy Dan Neville

I apologise for being late but I was listening to the debate on the monitor. I do not want to repeat what everyone else has said but would like to touch on one particular area, namely, community-based services. All those who can prefer to stay outside of residential care, but while lip service has been given to supporting this since 1984, little progress has been made. Why are community services not provided for those who do not need to go into residential care? Community care was one of the recommendations of the reports. Have there been any developments in this area and why are community services developing so slowly? It seems they are moving at a snail's pace, if at all.

I would also like to mention two other issues. It has just been announced that suicide rates for the past year went up by 24%. I will not dwell on this in detail because it is not part of this discussion. However, could we have a quick comment from the director on the HSE response to the increase of 24% in the incidence of suicide in 2009? There is much concern about the admission closures in three psychiatric hospitals, St. Ita's, St. Brendan's and St. Senan's, and there appears to be no provision for accommodating patients who will present in the future. Can the delegates throw any light on where patients who require admission to these hospitals will be accommodated once the recommendations of the report of the Inspector for Mental Health Services are put in place?

Deputy Jan O’Sullivan

I will be very brief. Deputy Neville raised the issue of community services and Ms Nic Aonghusa spoke about reconfiguration of staff. I am outraged that at the same time as we are talking about moving services to the community and reconfiguring staff, there are so many threatened cutbacks in these services. I have attended three protests in this regard between yesterday and today. Yesterday, 63 families from Limerick protested because of the closure of respite services. The people concerned are part of the community in that they live at home, but they are now denied respite because of cutbacks. A group from the Navan Road which is affected by cutbacks in the services offered by the Daughters of Charity there is outside Leinster House today, and I also met a group from Kildare who are concerned that their respite centre will close soon. There is a lovely theory about moving into the community, but people who live in their homes where parents or relatives care for them are being denied respite services. Some of these are adults with intellectual disability. This situation is a disgrace. We can theorise all we like but the situation in practice is very different.

I do not want to rehash what others have said, but I would like to pay tribute to Margaret Kennedy. I read the report of the committee meeting we had on Tuesday, 24 June 2008 which the Chairman circulated to members. I understand the Chairman's point that the people here today were invited to respond on the issue of the recommendations of the McCoy and Hynes reports. However, the Hynes report is very disappointing and the issues raised by Margaret Kennedy are not dealt with in either it or the McCoy report. I agree with Deputy Shatter that this committee must return to the issues that have not been addressed and accept that our main objective is to learn for the future. However, the families of the 22 people who came forward, 21 of whom made allegations of abuse, and the 130 people who went to the Residential Institutions Redress Board have not got any answers to what happened to them while they were in care in Galway.

Ms Margaret Kennedy, for example, raised the issue of transparency about what was investigated and what answers were provided for what happened at the time. She asked whether there was any tracking of where those Brothers of Charity who were found to have abused worked afterwards in Ireland or in Britain. Mr. Patrick McGinley, who represented the Brothers of Charity at the meeting in 2008, said he was acutely aware that serious sexual and physical abuse had taken place in Brothers of Charity facilities. There was clear acceptance, therefore, that there was serious sexual and physical abuse, but none of the reports produced over this period has provided any information about what actually happened. We cannot allow it to rest at that. When this issue arose in 1999, it was at a time when we saw programmes on television exposing issues of abuse and the Taoiseach of the day made an apology on behalf of the State. Things started happening then, such as the Commission to Inquire into Child Abuse and the setting up of the Residential Institutions Redress Board and so on. Therefore, the issue was in the public domain at the time.

I presume the intention behind the inquiry that was set up was to find out what happened. However, we do not have any real knowledge about what happened at the time to the victims and there are many questions still to be answered. I understand that the delegates are here to respond to the McCoy and Hynes reports, but I would like to ask whether the Department of Health and Children and the HSE believe outstanding issues need to be clarified with regard to what happened in Galway.

Chairman

Would Mr. Reaney like to respond first?

Mr. Ger Reaney

Shortly after the publication of the McCoy report, I was the person with responsibility for disability services for the HSE. I spoke to this committee when we last discussed this issue two years ago, so I will address some of the issues that have been raised while Ms Kennelly will deal with more current issues.

I will attempt to summarise the issues raised. First, it seems our response this afternoon is being heard as being more aspirational than actual, especially as articulated by Deputies Conlon and O'Reilly. Second is the findings of the Hynes report and the adequacy or otherwise of the investigation and whether this is learning for the future or the present and whether another inquiry is required. Third, some of the details of the processes of the inquiry, the inquiry that preceded McCoy, around issues such as the support individuals received, etc. Fourth, I understand most of the issue of standards will be addressed by the Department. Fifth, issues relating to community services, some of which relate to people with disabilities and some of which relate to people with mental health issues. Neither Ms Kennelly nor I currently have responsibility for mental health services. Ms Kennelly will address some of the issues as they pertain to people with disabilities.

It may have been the manner in which we communicated it and, if so, we apologise to the committee for not communicating clearly enough. It has been said that the McCoy report has been a form of learning for the future. The learning started in December 2007 and I will illustrate this point.

I have in front of me a list of the full recommendations from the McCoy report. It gives some examples and addresses some of the specific issues raised by members. The McCoy report recommended that all applicants for a service from the Brothers of Charity should be fully assessed before being admitted to a service. This has been in place now for some time and all new admissions to a service have an initial assessment which involves a psychiatrist and a social worker. The Brothers of Charity will provide information leaflets to all new applicants. An induction programme has been in place in all services for some time. Prior to admission, a person-centred plan will be developed for each service user by a multidisciplinary team. This obviously created some confusion in our earlier communication but I assure the committee this is now in place and has been in place for some time for all service users in all Brothers of Charity services. What we communicated was that the Brothers of Charity, in agreement with ourselves, extended that recommendation of the McCoy report to include existing service users. As of the beginning of this year, a person-centred plan was in place for all the existing service users in five out of the six Brothers of Charity services and the sixth service will have that in place by the end of the year. The recommendations of the McCoy report have been met and we have gone further than that by having a person-centred plan for all individuals.

Some other examples of the recommendations include that a code of conduct should be in place for all staff, in both Holy Family school and in the Brothers of Charity and this is in place. Deputy Reilly raised the issue of what would happen the staff who do not adhere to the code of conduct. The code of conduct is part of their conditions of employment and anyone who does not abide by this code, in the same way as not abiding by any other condition of employment, will be subject to disciplinary action.

We gave an outline of training in our presentation. One of the members referred specifically to training. I have a list of all the Brothers of Charity services in which staff have received training in the care of vulnerable clients. In Limerick, all current staff have been trained. Training began in Cork as of 19 October and as it takes six months to complete training, all staff should have been trained at this stage. In Clare, four refresher courses are being run. I apologise if we did not communicate clearly enough the extent to which the recommendations were implemented. I can provide more detail if so required by members.

Deputy Shatter asked questions about the Hynes report. We fully accept the findings of the Hynes report that the investigation had a lot of shortcomings. I can absolutely assure members that this is not the type of investigation we undertake today. I draw the attention of members to page five of the Hynes report where Mr. Hynes points out that this was the first inquiry of its type and that there is now a greater level of understanding of the difficulties involved in establishing inquiries, with that benefit of eight years of hindsight. Mr. Hynes found there was no indication that anybody involved was less than fully committed and this would include, I believe I am correct in saying, the regional management of the Western Health Board who established the inquiry and were responsible for dealing with the inquiry's resource requests.

Deputy Alan Shatter

I suggest Mr. Reaney deal with what occurred in the Brothers of Charity situation.

Mr. Ger Reaney

I propose to address all of the Deputy's queries. I cannot find the reference just at the moment but members will be aware, having read the Hynes report, that Mr. Hynes sets out quite clearly that from its formation in 2005, the HSE prioritised the completion of this process and set a timeframe for its completion. The HSE reviewed actions on a regular basis to ensure that the timescale was adhered to. An external consultant, Dr. McCoy was called in. Members will accept there is nobody better qualified in this regard. When the chairman was unable to continue, Dr. McCoy was asked to complete the report.

This report was quoted as learning for the future. I draw the attention of members to our current method of conducting inquiries. In March 2008, the HSE established a serious incident management team. This was well in advance of the completion of the Hynes report. It extended to all investigations and all of the wide range of services provided by the HSE. Both Ms Kennelly and I are here with regard to our roles in dealing with services for those with disabilities and we are not in a position to comment on child care as we are not fully briefed on that aspect of care. We are prepared to address the comments in the context of services for those with disabilities.

The serious incident management team was established in March 2008. A set of policies and procedures for reviewing and managing serious incidents was published later that year, drawing from existing documentation available within the HSE and from best practice. Subsequently, in April 2009, the serious incident management team circulated to all elements of the HSE and all our funded agencies, a set of standard documentation for the management of investigations, reviews and queries. Particularly relevant in the context of Mr. Hynes's findings and the McCoy report is a template for review, a template for terms of reference and a template for report. We fully accept that the terms of reference was one of the major difficulties with regard to the McCoy report. We are currently in the process of finalising a revised standardised procedure for investigation on which we have been working since 2009. A consultation process is currently under way. Members will be aware that with regard to these inquiries the HSE is accountable not just to internal stakeholders, to its service users, but also to a number of external agencies including the Health and Safety Authority, HIQA, where applicable, the Coroner's Court, etc.

On the question of whether another inquiry is required, I respectfully suggest that I am not the person best qualified — or perhaps the HSE is not best qualified — to make that judgment and members may need to make that judgment themselves. However, I need to draw to the attention of the committee that prior to the publication of the McCoy report, the HSE established a number of internal reviews of the Brothers of Charity services in Galway. One in particular, which received some attention, was published either prior to or at the same time as the McCoy report, was called the Murphy-Mulvihill report. This was a review of the current procedures at the time in the Brothers of Charity services in Galway and to establish and give assurance to the HSE of the safety of the individuals in those services at that time.

Chairman

I apologise to Mr. Reaney but a vote has been called in the Dáil.

Sitting suspended at 4.50 p.m. and resumed at 5.05 p.m.

Chairman

I think there will be no more votes for a little while. I invite Mr. Reaney to continue responding to the questions of members. Perhaps he should not reply to Deputy Shatter's questions until the Deputy returns, so that he will not have to repeat himself later in the meeting. I advise him to deal with the matters raised by other members. He can return to Deputy Shatter's points at a later stage.

Mr. Ger Reaney

I thank the Chairman for his suggestion. Before the suspension of the sitting, I was talking about the comprehensive work that has been done to establish the safety of service users and to ensure the files and records that will be made available to any future inquiry will be used effectively, in terms of liaising with the Garda, etc. I can return to this issue when Deputy Shatter returns.

The third heading I propose to address is the detail of the processes. Deputy Reilly asked who the complaints officers were. The Health Act 2004, elements of which were implemented in 2007, provides that each health service is required to have a complaints officer who is independent in that function. The national complaints office of the HSE holds all services, including services in the voluntary sector, to account. Such services are required to report to the office in respect of complaints received and to ensure the standard complaints process is observed. I can give the committee details of the number of complaints received by the Brothers of Charity over recent years. Those statistics illustrate that the process is working.

Deputy Shatter also raised the issue of advocacy structures. With the possible exception of the mental health sector, the Brothers of Charity service is one of the more proactive areas of the health system, when it comes to the use of advocates. Each Brothers of Charity county service has an advocacy group that elects members to the regional council of the service. There is also a national advocacy group. Well-defined structures have been in place for a number of years. The advocates are supported by staff members. Three of the Brothers of Charity services — those in Cork, Clare and Galway — are supported by advocates funded by the Citizens Information Board. As members are aware, the board has statutory responsibility for advocacy services. One of the initiatives we put in place after the publication of the McCoy report was to ensure the records were standard and contained all the information available. They will be available to HIQA or any other body with a statutory right or function to review the Brothers of Charity Services.

Deputy Reilly raised issues about whistleblowers. He may have been referring to legislation. I refer him to Ms Kennelly's submission, which states the HSE has implemented what we call a good-faith policy to encourage people to come forward without blame and give people protection who report matters of concern. That is a proactive and positive initiative to address the Deputy's concern.

Deputy Alan Shatter

If one is suffering from a disability and is a victim of abuse, to whom does one talk? How does one know whom to contact?

Mr. Ger Reaney

Each organisation has a designated person. As part of the induction programme, the procedures and designated individuals are made known to each service user and his or her family. In reality, most service users talk to a staff member they work with on a day-to-day basis. The critical point in ensuring effective policy for reporting and managing abuse is to ensure all staff are aware of the procedures and the identity of the designated person. It is also critical that the procedures be reviewed on a regular basis. One of the recommendations we implemented following the McCoy report was to ensure reports of abuse and complaints would be reviewed by a senior manager annually.

Some other issues arose regarding the processes associated with the McCoy report. Deputy Kathleen Lynch asked about whether people with disabilities were supported in coming forward and giving evidence to the inquiry, and whether the interviewers had appropriate experience. Members may recall from the last hearing in respect of the McCoy report that the interviewers were two qualified psychologists with experience in the area of intellectual disability. They would have been deemed to have been the most appropriate people.

A number of members have drawn attention to the fact that no conclusions were drawn. Mr. Hynes refers to it not being possible to draw conclusions regarding the culpability of individuals. However, clear conclusions were drawn in terms of a number of issues, namely, that abuse happened, that the organisation, in its management and service delivery, has serious shortcomings. The Brothers of Charity have apologised unreservedly for this on a number of occasions. The HSE would acknowledge its shortcomings as funder and supervisor organisation. We have learned lessons in this regard and will ensure what occurred will not happen again.

A number of members referred to the tracking of individuals. All individuals who are identified in the inquiry and about whom concerns were raised, whether they were found culpable or otherwise, were tracked. Most had retired by that stage and it was established beyond doubt that none was working in this jurisdiction or, in so far as it could be determined, in the United Kingdom, including in Brothers of Charity Services in the United Kingdom. All possible steps were taken to ensure identified individuals were not working in services. We assure members they are not working with vulnerable people in this country.

Deputy Kathleen Lynch raised issues about one individual doing certain tasks single-handedly in the latter stage of the inquiry. It is fair to say Mr. Hynes records a difference of opinion between the chairman and the regional managers in terms of the resources required and provided when setting up the inquiry. The resources were provided and I cannot go any further today than Mr. Hynes did; suffice it to say there was a difference of opinion between the chairman and the regional manager. Mr. Hynes points out that all individuals, including those to whom I refer, were committed to the inquiry and its conclusions.

Deputy Conlon stated the system failed people. That is absolutely true and the Brothers of Charity fully accepted its culpability and shortcomings in that regard, as did the HSE as funder of the service. That is why we implemented all the recommendations in the McCoy report. As part of the service arrangements we implemented in the past two years with disability organisations, we have ensured systems are in place for the organisations to be accountable to us regarding how they adhere to standards, deal appropriately with complaints and record abuse.

With regard to Deputy Shatter's points, I do not believe it is for me to comment on whether there should be another inquiry. Members' attention must be drawn to a number of issues. Prior to the publication of the McCoy report, we implemented a comprehensive review of current policies and their implementation in the Brothers of Charity Services in Galway. The review was carried out by two experienced HSE managers from outside the area and who were not familiar with the service. They produced two reports, in April 2006 and November 2006. Those reports are on the public record and are available to members. They provided substantial assurance but also identified areas for improvement. These areas have been addressed and we have followed up on them with the Brothers of Charity to ensure the recommendations were implemented.

We identified an experienced child care manager to go through the files in the Brothers of Charity with a view to identifying where investigations and concerns had not been followed up appropriately. One of the actions was to refer all appropriate files to the Garda. That led to Garda investigations in some instances.

Deputy Kathleen Lynch identified the key concern, that is, to ensure the abuse cannot happen again. The HSE has done everything it can and has provided the highest level of assurance in this regard. It is probably a duty of members to reflect on the value of going back over what happened.

There are particular points raised by Deputy Shatter that are worth considering. Twenty-one members gave evidence. A further 20 members, approximately, contacted the inquiry but indicated they did not want to give evidence. I understand substantial support would have been available to them. We need to accept that some individuals may want to record they were abused but not tell their story at an inquiry.

One hundred and thirty-three people came forward to the redress board. It is worth noting that the Brothers of Charity were very proactive in encouraging people to consider their opportunity to go to the redress board and contacted each of its service users in that respect. Given the timing of the redress board, this occurred a number of years after the actual evidence had been taken for the inquiry. The terms of reference for the redress board would be slightly different from the criteria for proceeding on foot of the inquiry.

Deputy Shatter asked about standards and the difference between guidelines and standards. It is worth drawing attention to Dr. McCoy's comprehensive recommendations to ensure every possible measure would be put in place so the appalling abuse could not happen again. Two of his recommendations related to the fact that HIQA would devise standards, which it has done. It is the only body that can put in place standards. Dr. McCoy also recommended that the HSE put in place documentation and policies to ensure that it had substantial assurance in respect of the Brothers of Charity services it funded. That is why, in December 2007, it prepared guidance documents, first on children and subsequently on adults.

When HIQA published its standards in May 2009, those standards superseded the guidance documents. Adherence to the guidance documents was optional for service providers but that did not mean they were intended to be taken less seriously than standards. It is not within the remit of the HSE to write standards as that is the responsibility of HIQA. As soon as HIQA publishes its standards for children's services, they will subsume our guidance documents on children.

Ms Kennelly may want to elaborate further on that.

Ms Ann Kennelly

The HSE takes seriously its role and responsibility in protecting people who are vulnerable in the care of the State and those in disability services. The HSE has made serious commitments to this with a significant amount of resources devoted to ensuring that lessons are learned in the sectors.

It may seem that we are going over old ground with writing policies and procedures. The way we approach these matters may seem tedious. However, there is a strong commitment of resources to staff training and creating awareness of warning signs. There is also a strong commitment to clear polices and procedures that staff need to understand, verify they understand and sign up to. It is about best practice and ensuring staff can deal with warning signs. It is about putting in place safeguards, maintaining records, meeting agencies, completing audits and reviews. By accomplishing all of these, the HSE can be confident these measures are taken seriously by all agencies.

Given that there are more than 270 agencies involved, there must be a process of systematic engagement. We have in place service contracts with service agencies that outline certain specifications to ensure they meet their obligations in protecting vulnerable people. The HSE can be assured of responsibilities being met through the regular collection, monitoring and validation of information. We also have established the external and outward reporting of incidents of abuse and reviews. When these incidents occur and are monitored, management within the HSE will oversee how they are dealt with. It also ensures these reviews and examinations are undertaken properly and in accordance with guidelines.

The HIQA standards will strengthen our processes. I hope I have demonstrated through my submission, our words and actions that we are taking this matter seriously.

The HSE and the agencies are very involved in risk identification. We sit down and outline the potential risks. We try to look forward, not always look back. We examine our systems and current practices to see how we can achieve the optimum. We establish potential risks and our vulnerabilities in this regard and then set out an action plan. It is not an action plan of intention but of targeted measures. Managers and agencies outline these measures, document and monitor them and ensure they are put in place. It is about constant learning and empowering staff, managers and service users to feel confident in the services provided.

We are working closely with the Department, service providers and key stakeholders in developing the policy and vision as to where services are going. Our services are becoming more orientated towards being located in the community with participative services for people instead of being based in segregated or institutional settings.

There was a query about the reduction in resource allocation for respite services. The overall reduction in resources for disability services comes about as a result in the reduction of the public service pay scales which is a budget-neutral reduction in resources. There is also an agreed value-for-money efficiency target of 2% which applies to the agencies, as well as a resulting impact of the national policy on public service employment levels. A reduction in staffing levels has had an impact on section 38 disability service providers.

This has not resulted in service reduction in the majority of agencies. The majority will maintain 2009 service levels, although they may find themselves struggling to achieve this. The HSE will meet locally with those agencies that have expressed difficulties with maintaining 2009 service levels to agree an implementation plan on how to offer options on maintaining respite services. More than 5,000 people were in receipt of respite in 2009. We will do everything we can to work with those agencies which declared difficulty in maintaining 2009 service levels to ensure they can maintain them.

The HSE has a mandate to ensure its resources are targeted at front-line services and services such as respite are not adversely affected. It must also ensure the resources are spent in meeting service users' needs. The value for money policy and review of resources will guide the HSE in evaluating how the system can target resources to meet the identified needs of an individual's care plan whether they are in residential, day or respite services.

Ms Bairbre Nic Aongusa

Deputies Conlon and Neville raised the issue of community-based services, the importance of service users and their families being consulted and giving them an element of choice and control of services. I fully agree with these sentiments. It is that desire to ensure service users have choice and control which is at the heart of the current policy review under way.

Currently, the way services are configured, service users do not often have a choice. They are clients of a certain agency and avail of whatever services are on offer. The policy review is examining the different ways services might be configured to allow service users more choice and control over their lives.

In my opening statement I referred to the €3 million fund designed to incentivise service providers to try new models of care. In fairness, many of the service providers in the voluntary disability sector are already developing new types of services and availing of this funding. They agree there is a need to change existing models of service.

I appreciate that the pace of reform appears to be slow. It is important, however, for us to examine how resources are allocated within services because another concern is the need for more clarity, accountability and transparency in where the funding is allocated and spent. As I stated earlier, €1.6 billion is spent on disability services annually.

Deputy Shatter and others referred to their disappointment that standards for disability care have not been put on a statutory basis. Ideally, we would like to have the HIQA standards placed on a statutory basis. In the current climate the job of the Department of Health and Children is to advise the Minister on priorities. There is an issue of resourcing and of capacity.

HIQA has a number of responsibilities at present on standards and inspections, notably in the areas of older people and children. There are additional commitments in the Ryan implementation report for HIQA to take over. Foster care, children in care and children with disabilities will all require inspection of services under commitments given in the Ryan implementation plan. As I mentioned in my opening statement, the Department is in discussion with HIQA at the moment in the overall context of all the responsibilities that it is being asked to take on in the context of the Ryan implementation plan.

Into that mix is being put the question of statutory standards for adults with intellectual disability in residential settings. The Ryan report explicitly recognised the vulnerability of adults in residential care. We are preparing proposals for the Minister to bring to Government on this. Deputy Conlon wondered about time lines. The Ryan implementation plan indicates the end of this year as the target date for children in residential care with disabilities to be brought in under inspection. That is being addressed at the moment by HIQA and it is currently preparing national standards for children. The ones it published are in relation to adults, and that is being looked at as well.

On the question of a future inquiry which was raised by Deputy Shatter, this certainly was considered by the Department when the Hynes report came in. In the Department we need to reflect, given the limited resources and capacity, on the best approach, for example whether the best use of our energy and focus would be to go back over events of more than 30 or 40 years that have already been investigated and about which action has been taken, as Mr. Reany outlined; or whether, first of all, a better use of resources would be to focus on the fact that arrangements are in place in existing facilities to ensure that this type of abuse does not happen again. More importantly, it will be necessary to move forward with the process of reform to ensure that the very institutions which gave rise to this type of abuse are phased out. In that context I draw the attention of members to the comments in the McCoy report, where Dr. McCoy says modern thinking on residential care emphasises that it is the settings for services rather than a service itself that is important. Historically, it is evident that residential services and any service that caters for vulnerable people in settings that are apart from, or separate from the community, run the risk of developing practices, which even unintentionally, are not in the best interest of service users.

Therefore, the long-term policy goal for the Department would be to move to phase out institutional care in mental health services and in disability services areas. It is in view of that priority that we are focusing resources on the policy review and framework and on the value for money review, to ascertain whether a better model of service may be achieved from existing resources.

Members might reflect, again, on the question of re-opening an inquiry. For people with disabilities who have already been subjected to abuse, the process can be quite stressful and distressing. It has been mentioned previously by survivors who participated in the redress board scheme how difficult that process was. As Mr. Reaney has said, while it is not up to me to determine whether an inquiry should be held, these are legitimate questions that need to be reflected upon, particularly given that the scope for the McCoy report was from 1995-98, and that the initial inquiry began more than 11 years ago.

From the Department's perspective we would like to focus our energies on ensuring that safeguards are in place to ensure that vulnerable people are protected; and that policy changes and changes in funding and models of service take place to ensure that we move away from institutional care which heightens the risk of abuse.

On the issue of the cuts in respite services that were referred to by Deputy O'Sullivan, as Ms Kennelly mentioned, in regard to whether they should be cut, in some agencies respite services have not been cut, while in others they have. That is relevant to the type of questions we are asking in the value for money review — for example, why some agencies can provide a service at a certain cost and others cannot and whether different models could provide the same or better levels of service for equivalent funding. Service users have certainly told us in the consultation process we have undertaken that they do not have a service at the moment which meets their needs. We need to look at that in a fundamental manner, which we shall do in the value for money review.

Chairman

I thank Ms Nic Aonghusa for those replies. We appear to have covered most of the ground. This is a subject matter that we need to return to, perhaps, in committee to decide whether we have particular recommendations to make. In the meantime, we are very grateful for the presentations and the manner in which the questions were dealt with. We certainly have had our memories refreshed on this matter and now have a much better understanding of the situation at this point. If members are happy, we shall return to this, and it will be on the agenda for the next meeting when we can decide if we have particular recommendations to make.

I remind members that an Australian delegation led by Senator the Honourable John Hogg, President of the Australian Senate, will visit the House tomorrow. An informal meeting has been set up with him and members of the committee, if people are available. The meeting will take place in Committee Room 2 at 3.30 p.m. Deputies Lynch and Reilly have confirmed that they are available.

The committee adjourned until 10.30 a.m. on Tuesday, 13 July 2010.