Health (Amendment) Bill 2016: Second and Subsequent Stages

Question proposed: "That the Bill be now read a Second Time."

I thank Senators for giving me the opportunity to address this legislation. I am pleased to attend the Seanad and introduce the Health (Amendment) Bill 2016. The Bill is a technical amendment to the Health Act 2007 with the sole purpose of extending by two years an existing transitional period provided for in that Act. The transitional period is currently due to expire by 31 October 2016, but this Bill will extend that date to 31 October 2018.

The Health Act 2007 provided for the establishment of the Health Information and Quality Authority, its inspection and regulation of designated centres and the framework for registration of these designated centres. "Designated centre" is the term used in the Health Act 2007 to describe residential centres in three broad categories: those for people with disabilities, those for older people and those for children. The measures provided in the Health (Amendment) Bill 2016 relate exclusively to residential centres for people with disabilities.

It was planned that all designated centres for people with disabilities would be inspected and registered by HIQA or else be refused registration within a three-year period after the relevant section of the Health Act 2007 came into effect. A provision contained in section 69 of the Health Act 2007 ensured the centres would be allowed to continue operating, subject to the full rigours of HIQA inspection regime, during the three-year period as if they were already registered. This period is now due to expire by 31 October 2016. Due to the complexities of the disability sector and in some cases the significant quality and safety issues identified by HIQA in the first two years of regulation, HIQA alerted the Department of Health in 2015 that it would not be possible to complete a final registration decision for all designated centres which had been deemed to be registered in this way by the end of the transitional period on 31 October 2016.

There are approximately 1,000 residential centres for people with disabilities throughout the country. By June 2016, a total of 556 had been registered - that is to say, 556 are now in the mainstream system. HIQA estimates that more than 350 centres will not be registered by the end of October 2016. It is important to understand the serious consequences if the deadline is not extended. Under the existing legislation, HIQA would be obliged to cancel the transitional regulation of a large number of centres. The Health Service Executive would be required to take over the running of these centres and make alternative arrangements for residents of the centres taken over. This would have major implications for the residents living in the centres, as well as significant budgetary, administrative and staffing implications for the HSE and the Department of Health. Moving residents out of these centres would be very difficult, as there is no spare capacity in the disability sector, unlike, for example, the nursing home sector. Where alternative accommodation was available, extreme care would have to be taken with any move to protect the high proportion of vulnerable residents whose needs must be paramount in any decision made.

The Health (Amendment) Bill 2016 is a technical amendment to the 2007 Act with the sole purpose of extending the transitional period by pushing out the final deadline for registration of centres for people with disabilities by two years. The Bill has no impact on the registration or regulation of residential centres for older people or children. It is important to point that out. The proposed two-year extension will not limit or diminish the responsibility of providers to manage and operate the services under their control. That is another key aspect of this legislation. Nor would it limit HIQA in the application of sanctions or powers of enforcement. HIQA is in full agreement with extension of the timeframe proposed in the Bill. Furthermore, no additional cost to the State is involved in extending the timeframe for registration by HIQA of centres for people with disabilities.

In addition to the need to avoid the significant disruption that would be caused by a large number of centres becoming unregistered all at once, the extension of the timeframe for meeting the registration requirements will be beneficial to the process of de-congregation of residential settings. In the disability sector in recent years the settled policy has been one of de-congregation, with large congregated facilities to be closed over time and people living more independent lives in smaller residences in the community. That is something I am pushing. The extension of the deadline by two years will allow service providers more time to pursue this policy.

It will allow HIQA to take a more measured approach in dealing with the problems in these old-style institutional facilities which were never envisaged as compliant with current standards and regulations and will help to smooth the transition to a fully regulated sector.

One of the key aims of the Government is to provide services and supports for people with disabilities that will empower them to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This is a fundamental change in the way services and supports for people with disabilities are currently provided. There is an onus on us to implement this change in a way that works effectively for people with disabilities and is financially sustainable, accountable and transparent. In that regard, underlining the Government's commitment to the disability sector, I recently announced additional funding of €31 million for disability services in 2016. This funding is in addition to capital funding of €100 million over a five-year period and it will be focused primarily on moving people out of congregated residential institutions.

While the Bill will help to facilitate the move towards de-congregation, it is worth noting again that it will have no cost implication for the State. The Health (Amendment) Bill 2016 is relatively short legislation, providing only a minor technical amendment to section 69 of the Health Act 2007. As the Bill is technical in nature, to assist Senators, I propose to outline the specific provisions of the Bill to clarify the intent of each.

Section 1(a) amends the key definitions contained in section 69 of the Act. These substitute provisions will ensure the extension of the transitional period provided for in the Bill will apply only to residential centres for people with disabilities and not to other categories of designated centre. At the request of the Department of Children and Youth Affairs, the definition of "Institution" contained in section 69(l) of the 2007 Act is to be amended to specifically exclude any effect of section 69 provisions on special care units for children. A separate transitional period in respect of these units is set out in section 48 of the Child Care (Amendment) Act 2011.

A new definition of "relevant day" is also included in the amending provisions. This reflects the fact that the legislation applicable to the different types of designated centre came into force on different dates for each category. For example, designated centres which are public or private nursing homes have been subject to regulation and inspection by HIQA since 1 July 2009. The "relevant day" when the legislation came into effect for centres for persons with disabilities is 1 November 2013, and this is reflected in paragraphs (e)(i) and (c)(ii) under the definition of "relevant day" in the new section 69(1) substituted by this Bill. The "relevant day" when legislation came into effect for the other types of designated centre is also provided for, but the transitional period in respect of the other centres is not extended by section 1(b) of the Bill. The clear indication of the different "relevant days" for the different types of designated centres is essential. The original definition of "designated centre" is contained in section 2 of the Health Act 2007, as amended by the Child and Family Agency Act 2013. The Health (Amendment) Bill 2016 as drafted ensures the measures to extend the transitional period in respect of centres for people with disabilities will not have any effect on the transitional period for any other type of designated centre.

Section 1(b) of the Health (Amendment) Bill 2016 extends the timeframe for a final decision on registrations solely in respect of designated centres for people with disabilities. It does this by replacing subsection (2) of section 69 of the Health Act 2007. Section 1(a) of the Bill defines centres for persons with disabilities as institutions to which paragraph (c) of the definition of "relevant day" applies. Section 1(b) goes on to state a person who was carrying on the business of an institution and providing residential services at the institution may continue to do so in the case of an institution to which paragraph (c) of the definition of "relevant day" applies for a period not exceeding five years and commencing on the relevant day. This means that centres for people with disabilities would be able to continue to operate without a registration decision until 31 October 2018, five years after the relevant legislation came into effect on 1 November 2013. For all other types of institution governed by the Act, the period of time in which they can operate without a registration decision remains at three years. There is no change for the other centres.

While the provisions are complex in their drafting, I emphasise that, overall, the Bill seeks to change one small matter relating to the system of HIQA inspection and regulation of centres for people with disabilities. It seeks to make this change without affecting in any way the other types of residential centre, be they nursing homes, special care units or residential centres for children in accordance with the Child Care Act 1991.

The extension of the transitional period in respect of centres for people with disabilities will ensure all such centres continue to be thoroughly inspected, monitored and assisted to reach the standard of operation required since regulation of this sector commenced in November 2013. It will not in any way limit HIQA in the application of its sanctions and considerable powers of enforcement. That is an important point to remember. The consequences of failing to extend the registration deadline would be severe, both in terms of the impact of a forced change of circumstances on some of our most vulnerable citizens and in terms of staffing and financial implications for the Exchequer.

I thank Senators for their attention to what is a complex but ultimately technical issue. I commend the Bill to the House.

I welcome the Minister of State. With my party, I will be supporting the Bill. I am disappointed that it is necessary and that there are still many residential centres that are non-compliant with HIQA regulations. While I appreciate that measures are being taken to make said centres compliant, it is unfortunate that the deadline needs to be extended by a further two years. Ideally, Fianna Fáil would like to see more people with disabilities living independently and less need for residential centres. However, as long as we have them it is important that they are well regulated and compliant with regulations.

The Health Service Executive, HSE, funds services for approximately 8,000 people in residential support settings, including 1,400 places at HSE-run units at a cost of €900 million per annum. The Health Information and Quality Authority, HIQA, which today published its annual overview report, assesses disability homes against 18 standards during each inspection, including residents' rights, health and welfare needs, staffing levels, medication management and governance. On publication of today's report, Ms Mary Dunnion, chief inspector of social services and director of regulation at HIQA, said the initial inspections carried out in 2014 had found that there had been a lack of understanding of how to meet the requirements of regulations and standards and that where there had been competent people in charge who had sufficient oversight of the quality and safety of the service being provided, centres had been able to meet the regulations and standards. It is important to note that where there were competent people in charge standards were met.

In 2015 HIQA carried out 561 inspections of the 937 designated centres for adults and children with disabilities. There were 741 inspections in total. At the time more than one third of the HSE-run homes inspected did not comply with any of the standards. For example, in Cregg House in County Sligo where there are 108 residents there was major non-compliance in 19 of the 23 areas inspected: exits were locked, there were no push buttons nearby to facilitate an exit in the case of a fire, staff were constantly in reactive mode and patients had received excessive chemical restraint in the few months prior to the inspection.

Recently the HSE has taken control of three homes run by the Irish Society for Autism. The centres which care for 47 residents are Cluain Farm in Kinnegad, Dunfirth Farm in Johnstownbridge and Sarshill House in Kilmore, County Wexford. The criticism levelled at these institutions was damming. They were labelled as unsafe and chaotic. Again, drugs were used as chemical restraints, residents left the homes without being noticed or recorded, many residents self-harmed, management was poor, staff were badly trained and inspectors found deficiencies in the administration of anti-psychotic, sedative and pain relief medication.

In 2014 we had the horrendous debacle of the Aras Attracta controversy. How can any of us forget those degrading images of vulnerable human beings on our television screens? Their treatment flew in the face of any semblance of human nature. Regressive, neglectful care such as was highlighted cannot be tolerated. The answer, of course, is to move away from the congregated setting model and opt for more supported placements in the community. What is needed is integration, not segregation.

The HSE prioritised the transition of just 150 people in 2015. In December 2015 the projected outturn was only 112. The number of people living in congregated settings is 2,725. The programme for Government states its objective is to reduce this figure by at least one third by 2021. At this rate, it will be 2031 before everybody is out of a congregated setting. We must be mindful to respect the trauma residents can experience when being moved to unfamiliar surroundings and aware that unsupported relocation causes great stress. It is not all that long ago when a UN special committee on torture issued a report which came extremely close to describing institutionalisation as a form of torture.

While we will support the amendment, it is time to redouble our efforts to end congregated settings. It is time to redirect funds from this malfunctioning and often antiquated system to the people who can instigate change for the betterment of service users and to ensure the service user will be listened to through assisted decision-making legislation.

Sinn Féin will support the Bill. That said, we have concerns and there are areas in which we seek assurances. Perhaps the Minister of State might address them and provide answers.

The original purpose of the Bill was to allow HIQA to inspect all residential settings for people with disabilities and it was given a three year period in which to do so, from November 2013. As the Minister of State said, it will expire in October 2016. There are 1,000 residential settings for people with disabilities which require inspection. We had been informed that in the past three years, up to June this year, 556 had been registered. The Minister of State has corrected this figure, but several hundred still remain to be inspected. The amendment makes provision to extend the timeframe.

We understand the consequences for the HSE, service users and families were we not to support the amendment. It would cause extensive problems for all concerned. Our priority and utmost concern about the amendment is for service users and the implications of the extension for them. We are, of course, fully committed to the policy of moving people from congregated settings and institutionalisation which have kept people with disabilities and abilities hidden from society. Decongregation is happening at a very slow pace. Sinn Féin supports the amendment, although we recognise that it certainly will not speed up the process. However, we have to see the greater good. Our main concern, while supporting the amendment, is to ask why the process is taking so long. While we can understand the huge administrative task involved and the time it took to bed down the initial process, we ask for the exact factors which are causing the delay and backlog. We note that the issue was highlighted for the Department of Health by HIQA in 2015. At the time, it was outlined that it would not be possible to do it within three years. Is it a question of resources? If so, why are more resources not being directed towards HIQA to allow it to complete the work within the agreed timeframe?

There is, of course, the possibility that it is not a resources issue. It was brought to my attention yesterday after speaking to Inclusion Ireland that there seemed to be in existence a list of centres, drawn up by the HSE, that it was agreed would never meet the criteria required to be met to be registered. Will the Minister of State comment on this? Is it the case, therefore, that some service providers may be reluctant to submit the necessary documentation, knowing that ultimately their centres will be closed down once the inspection takes place? Similarly, is the HSE reluctant to carry out the inspection, knowing that it will have to shut down an existing centre and take on the responsibilities that go with it? Considering this, will the Minister of State provide me with exact figures for the numbers of centres which have already been inspected and registered and are HSE funded? If the existence of this HSE list of non-viable centres is confirmed, I will be extremely sceptical that this is no more than a kicking of the can down the road exercise, similar to what has happened in the case of water charges, banded hours contracts and bin charges. Is the requested two year period needed? The Minister of State has said 700 centres will be inspected by October. That leaves approximately 300 remaining. Will it take two years to inspect them? I really cannot work out the maths. Would it be better to opt for a shorter period of six, 12 or 18 months? Is the amendment being used as a tool to provide breathing space for the non-viable centres on the list and to meet the cost that would be incurred by the HSE?

Controversies and scandals have been uncovered by the media and HIQA in recent times, not specifically in disability residential settings but throughout the social care sector. There are more than 300 residential settings which have never been inspected. We are aware that HIQA has returned to settings that received unfavourable and damning reports many times, but this large number of settings remain uninspected, with the potential for service users to be at increased risk. Will the Minister of State comment on this?

Sinn Féin's vision for society is one in which all citizens, including those with disabilities, can play a full and independent part in all aspects of life, relying as far as possible on mainstream public health, education, employment and housing sevices, with the support of tailored disability services, where necessary. We further believe this vision should provide those with disabilities full autonomy and control over their own lives and services. In this context, will the Minister of State initiate the Assisted Decision-Making (Capacity) Act 2015? This would have a huge positive impact on those with disabilities and include them in making decisions on their lives.

I welcome the Minister of State. It is very appropriate that he is taking the Bill, given his long interest in this issue. To be helpful to the previous speaker, HIQA inspecting the premises in question will not cause a delay. The delay will be caused in premises meeting the standards laid down. Some of them face serious challenges in correcting physical surroundings which are no longer acceptable. Some involve serious engineering issues, including in listed buildings. Nonetheless, like everybody else in the House, I would have loved to have seen the issue addressed sooner, but we all realise the financial crisis the country was in and that money was not available. It is now and it is being invested wisely and appropriately in services for those who are the most vulnerable in our society.

It is important to re-emphasise that the Minister of State said HIQA will continue to inspect these buildings and ensure the care standards are met. That brings me to another point. Will the Minister of State confirm there will not be any fire safety or other safety issues that will imperil clients? Like Senator Keith Swanick, I believe we want to move to integration, not segregation. Having worked for 20 years in St. Ita’s Hospital with individuals with intellectual disabilities, I remember the horrors of Leas Cross and the paradox of the fact that people were moved there from old institutions with paint peeling off the walls. That was before I was involved in politics, but I am not trying to score points; it is just the reality. In the old institutions, the ethos and culture in respect of the patient or client was beyond reproach. Then they moved to the palatial surroundings of Leas Cross. In fairness to Deputy Fergus O’Dowd, he exposed what was happening there. The patients in Leas Cross had palatial surroundings but did not have care. To me, care comes first, and the ethos and culture that support that care are most important. Therefore, as we rightly plan for de-congregation and integration, we need to do so very carefully in regard to continuity of care, the knowledge carers have of patients and clients, and the relationship they have with them. The staff are acute observers of behaviour and know when a client is getting into trouble. They know the client's medical history and how he or she behaves. I experienced this and learned a considerable amount from the nursing staff at St. Ita's Hospital about individual patients.

I agree with Senator Keith Swanick about the circumstances in which flare-ups in behaviour were addressed by sedation, sometimes by the doctor on call, but after which the higher dosage of medication was left in place, such that the next time there was a behavioural disturbance, an even higher dose was prescribed. One could see the dosage rising. Going in as the regular general practitioner, I was always asked by the nurses whether I would not address this issue and take the clients off the higher doses when their behaviour improved. My point is about the skill and care of the majority of staff who look after the very vulnerable and disabled. We will always have outliers like Áras Attracta, and HIQA is in place to protect people in this regard. The importance of HIQA cannot be overstated. It is very important that we protect the most vulnerable.

We had a debate yesterday in the Chamber on housing, with a particular focus on people with a disability. If a Minister for Health speaks to any person with a disability, that person will say she does not know what she is doing talking to a Minister responsible for health, as she is not sick. Rather, she will say she has a disability and ask for help and support with that disability. That is what we seek to do.

When I was Minister for Children and Youth Affairs, I was very pleased to be able to introduce a new scheme to support children with special needs in the preschool years. In health, education or any other area, the earlier the intervention, the better the outcome and the better the value for money. One gets much better bang for one’s buck and much better outcomes.

We need to ensure that only in the most severe and rare circumstances do people with a disability end up in care settings of a larger nature. We really should be seeking to support many people with a disability at home in modified housing. They have a considerable amount to add to society. Very often, they have hidden abilities. We only have to go back through history to note people who were considered to be odd and not the intellectual match of their peers but who, in their given area of interest, were far superior and made some of the great discoveries of science. At the ordinary level also, they have so much to add. Children who are raised with children with a disability learn so much and have their lives enriched so much by it. The same applies to us as adults.

It is welcome that the Minister of State has been up front about this. As every other Senator has acknowledged, this is a very common-sense response to a set of circumstances. At the core must be the best interest of the client with the disability. This is a complicated issue to address across so many areas, as I have outlined. However, having said that, we look forward to HIQA's ensuring those who are more vulnerable with disabilities are protected when in the care of the State and that the various premises in which they reside, which are their homes in many cases, are safe and of a standard such that we would be happy to have our loved one therein.

The Minister of State is very welcome back. I welcome the contributions of fellow Senators who are making very important points that need to be made. As the saying goes, we are where we are. This Bill represents the prudent and logical approach. It is regrettable at another level that it was not possible to proceed more quickly.

I wish to make a few points on regulation in general. It was a long time coming but it is now happening. The reason for it is to benefit people with a disability. This must be considered in the context of the State's policy approach which envisages people with disabilities having maximum independence and ultimately the ability to participate in ordinary life in ordinary ways and to have relationships, an education, ease of movement, employment, etc. It is important to keep this in mind.

Since there have been so many lapses in or a lack of regulation in a range of areas, we often run into regulation or push it on. We must ensure our regulation is the right regulation. In a couple of years, when we have a chance to review how the regulation operates, we must bear this point in mind.

There are lessons learned already among organisations and service providers, including HIQA, the Department and the HSE. In all this, it will be most important to ascertain how we hear better and more clearly the voice of people with disabilities. We have the UN convention. The Minister of State assured us on this in the House a couple of weeks ago. It was mentioned again yesterday by the Minister for the Environment, Community and Local Government, Deputy Simon Coveney. It is coming our way very soon. We might as well be clear about the fact there will be tension to be addressed in a mature way and that we will have to strike a balance between a very well meant ethos of welfare and care, on the one hand, and liberation, choice and the autonomy of people, on the other. We will have to struggle with this. I am pretty sure we will not find the balance too easily.

It has taken a long time to get here. The Minister of State said one of the key aims of the Government was to provide services and supports for people with a disability that woujld empower them to live independent lives, provide them with greater independence and access to services they chose and enhance their ability to tailor the supports required to meet their needs and plan their lives. He then stated this was a fundamental change in the way services and supports for people with disabilities were provided. I take issue with that. It is true in so far as it concerns many people in residential settings but, for every one person in a residential setting, there are thousands struggling to stay with it in the community and stay living in their neighbourhood. Genuine issues arise about the supports they need, including personal assistants, a decent income on which to live and home supports.

We must remember that there are two worlds. There is the world of people who have been incarcerated in institutions, in effect, and there is the world of people hanging on by their fingernails to stay living in the community.

We hear considerable talk about the revolving door when it comes to prisons, but there is another revolving door in a sense. We are fixated with getting the 2,725 people down to zero. As Senator Keith Swanick said, at the rate targeted for the next five years it will take a further decade, 15 years in total, before that is concluded and we have not come close to meeting those targets in recent years. However, I was involved in a case about two years ago, since HIQA was established. A young man in his 50s became disabled as a result of a road traffic accident. He is a married man with three children. They are a fine family that really wanted to stay together. Someone from the HSE placed a fair deal application form before that man. This means that there are two different people sitting in offices in the HSE, one working on getting people out of congregated settings and the other suggesting the fair deal scheme as the best deal on offer.

We are only talking about gross figures when we are trying to get the numbers down. We also need to think about the people going into institutions of one kind or another, often nursing homes. That is happening because of a serious, unprecedented and rigorous chipping away at supports that keep people living in the community, including the PA hours cut and the home care packages cut.

I support the Bill. I hope the Minister of State will come back to address some of the wider issues raised today relating to independent living for people with disabilities. In particular, we need to address the issue of younger people going into other forms of institutions.

Like colleagues across the House, I have no difficulty in accepting the proposition before us that the two-year extension be granted, provided that in those two years we see very serious action and investment in the sector. We all know that there are congregated settings and other facilities across the country that require serious investment in terms of upgrading. I am aware, as others in the House will be, that a similar approach has been taken to the necessity to upgrade and ensure compliance for residential nursing homes in recent times. In order to extend and smooth the process, arguably, for compliance for residential nursing homes, the regime has been modified in terms of accommodation standards, which probably reflects a reality in that sector regarding the availability of funding.

I repeat what Senator James Reilly said. We always need to reflect on care and the culture of an organisation when we are talking about standards and the provision of services in institutional or residential settings, whether they be for people of varying abilities or for older people. In supporting this initiative to extend the timeframe, I am hopeful we will not see a relaxation of the regime and standards to be applied to residential settings for people of varying abilities, people with disabilities, because I could not support that. We need to stay true to the standards required.

I ask the Minister of State to confirm the level of capital investment that will be available in the coming two to five years to bring residential settings up to the required standard. I agree with Senator John Dolan who spoke very eloquently about the challenges the sector faces. He knows more than anybody else in this Chamber about those challenges.

It took a long time to get here. We have travelled a journey and it is very positive that we are moving in this direction. My party colleague, the former Minister of State, Kathleen Lynch, must take some credit for taking this initiative and ensuring in 2013 that we were taking a journey towards this state where the requirement for these standards would become part of the system and our response to the sector. It is about ensuring everyone in our society has a high standard of living and a high standard of support and care. We are all united in wanting to see the congregated settings broken up and people having the opportunity, as they should as equal citizens, to live independently with the support of the State and others.

When will Ireland ratify the UN convention which Senator John Dolan mentioned? I do not believe I was in the House when the Minister of State responded to that question a couple of weeks ago. Ireland is the only European Union state not to have ratified the convention at this stage. I look forward to us doing so and would appreciate being given a timeframe by the Minister of State for it.

I thank the Minister of State for coming to the House to discuss the matter. I believe all the issues I wanted to raise have been raised and I will not go back over them. Where HIQA makes decisions we need adequate follow-up within a reasonable period of time. I know that the Bill deals with that issue. This morning I met a group of people who raised concerns about a facility that had been closed down without adequate provision for where the people leaving the facility would be accommodated. It is important to have co-ordination of services where that arises. Senator James Reilly made the very valid point that in all the facilities covered by the Bill we needed to ensure no person would be put at risk.

I come to another matter that we have put on the long finger for a number of years, partly because of insufficient funding. Every week in my area I come across elderly parents who are looking after their children, often older people up to their mid-50s. Those parents are now finding it difficult to mind that child who has intellectual or physical disabilities. They find that all the doors are closed for them in getting support. They are worried that no facility will be available for their child when they are no longer there to look after him or her.

In Cork approximately 1,200 people are in residential care with Cope, with another 1,500 in day care. Owing to demand, that day care service may need to move to providing a far greater level of support. I am not sure we have done any long-term planning in that regard.

I am not sure if figures are available on the age profile of people looking after those who attend day care facilities. The demands placed on services in the next ten years will require that alternative means of looking after the people concerned will be needed. This is a serious concern. I spoke at lunchtime to a woman whose husband was on his way to collect the couple's daughter from a day care centre. The daughter is aged in her mid-50s and for the past 40 years, her father has been driving her to a day facility every morning and collecting her every evening. The couple look after her at home at night but they are growing older and are concerned because there are no other family members who can look after their daughter. We must be careful to ensure action on this issue is not delayed. All these centres should be up to scratch at this stage. While I accept that this issue has been ongoing for many years, the Department needs to address it immediately because it is a matter of increasing concern for parents and families.

Health services need to be co-ordinated between various health service authorities and local authorities. Demands are being made to adapt accommodation to make it easier for parents and local authorities. I raised previously a case involving a person with a severe physical and intellectual disability. To be fair, the problem was resolved but only after seven and a half years and the intervention of the Ombudsman, which is not good enough. We must send a message to local authorities and the health service that they must co-operate to a much greater extent to ensure people with disabilities are looked after and can continue to live in the community.

I thank Senators James Reilly, Keith Swanick, Máire Devine, John Dolan, Gerald Nash and Colm Burke for their support and the ideas they expressed. I will respond individually to the queries they raised.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for a Partnership Government which is guided by two principles, namely, equality of opportunity and improving the quality of life for people with disabilities. A key element of this is to safeguard and support the delivery of person centred care to vulnerable people of all ages who are receiving residential care services and to ensure their health, well-being and quality of life are promoted and protected.

It is clear that the establishment of the Health Information and Quality Authority, HIQA, and the introduction of its inspection and regulatory frameworks have gone a long way in improving the lives of people with disabilities in residential care. The National Disability Authority was asked by my Department to conduct a study of the first year of operations of HIQA inspections of residential centres for people with disabilities. The authority's review which was published in May last confirms the importance and necessity of the regulatory process, an issue raised by many speakers in this debate. It also confirms that the regulatory process is working effectively and protecting vulnerable people in the care of the State.

The purpose of the Bill is not to change any of the fundamentals of the inspection, regulation and registration regime for centres for people with disabilities. It will simply extend the existing transitional period in which residential centres are deemed to be registered in order to allow HIQA the necessary time to ensure every centre is inspected fully and properly. HIQA will not be limited in any way in the application of its powers and sanctions. It will retain its ability to inspect and, if necessary, cancel the registration of residential centres which persistently fail to meet the required standards. This is an important aspect of the legislation.

I will now address some of the issues Senators raised. Senator Keith Swanwick referred to the Áras Attracta facility. I was as shocked and distressed as others by the revelations at the end of 2014 concerning the extremely poor and unacceptable standards of care and mistreatment of vulnerable residents in the centre. An independent review of Áras Attracta's services was also commissioned and is nearing completion. I will ensure I am fully briefed on the findings and recommendations of the review. Anyone who has concerns about the treatment of vulnerable persons in our disability services is urged to contact the Health Information and Quality Authority which, I am assured, will take the matter very seriously and investigate it in the context of its significant regulatory powers of inspection of residential facilities.

Senator Keith Swanwick referred to three centres which were run by the Irish Society for Autism. The Health Service Executive has assumed responsibility for the governance and management of the three centres in question. The HSE has engaged external service providers to assist and manage the services on a temporary basis. I am very familiar with Gheel Autism Services, one of the service providers commissioned to assist in this matter. Significant progress is being made on the issues highlighted by HIQA, with a suite of immediate actions already completed. Appropriate plans to address more long-term regulatory requirements are being implemented. While HIQA's findings in cases such as these may make difficult reading, they also serve as evidence that the regulatory process works effectively in the interests of protecting vulnerable persons in the care of the State.

Cregg House in County Sligo which was mentioned is one of the centres prioritised for decongregation and the HSE is working to assist residents of the centre in moving to a new place of residence of their choice.

Senator Gerald Nash referred to capital investment in this area. Funding of €100 million has been provided for this purpose in the next five years.

Senator John Dolan referred to HIQA's annual overview report on the regulation of designated centres for adults and children with disabilities. The review was published today and according to HIQA, the introduction of regulation for residential centres for people with disabilities has brought about a positive cultural change in the sector. HIQA states that two years ago, initial inspections found that residents in many large congregated settings were not being adequately protected or kept safe. It adds that inspections steadily led to improvements in the standards of care in these settings. The review praises the improvements in care and states that last year HIQA inspected 561 of the 937 designated residential centres for adults and mixed centres for adults and children with disabilities. This is important, but I concur with Senator John Dolan on the need to develop the right type of regulation.

Senator John Dolan also referred to people with disabilities living in the community. I am committed to setting up a task force on personalised budgets as soon as possible and will finalise my plans in this regard next week. By the end of this month, I intend to inform the Government of my decision on the chair of the task force and outline my plans for the appointment of its members and the development of its terms of reference, objectives, scope and key deliverables. With the support of the Government, I will proceed to appoint members and arrange for its first meeting to take place as soon as practicable. I am, therefore, pushing the idea of personalised budgets.

Senator Colm Burke referred to people at risk and raised fire safety issues. I agree with the Senator's sentiments on these matters, all of which need to be prioritised, and will highlight them while in office. Senator Máire Devine raised similar issues. It is worth noting that by the end of April, all such centres had been inspected by HIQA at least once. The HSE and HIQA have agreed a priority list of centres which face the greatest challenges in meeting standards and all centres will be required to comply with the timeline.

I mentioned HIQA and the standards required. I think it was Senator James Reilly who raised the issue of old buildings. We have to ensure these buildings are brought up to standard. As I said, there will be major investment in them in the next few years. It is up to me to fight on these issues because we have to up our game.

A number of other points were made by Senators, including Senator Keith Swanick, on the issue of competent people being in charge. That applies to both the provision of services and the implementation of HIQA standards and regulations. It also relates to the treatment of people with intellectual or physical disabilities. That is something we have to improve. It is something that we discovered in some of the other cases that were raised by my colleagues. I believe it is important that we deal with these particular issues. On any particular issues that I did not respond to, I will come back to the individual Senators later on with a more detailed response.

The cases of a number of centres taken over by the HSE in recent months show us that the system of regulation works. There is a procedure in place to deal with centres that fail to meet HIQA standards. There is no exception in the case of centres covered in section 69 of the 2007 Act. The extension of the timeframe for registration will not affect this in any way. It will simply ensure HIQA has the time required to inspect every residential centre in the country for people with disabilities in the full and comprehensive manner required.

I hope I have addressed the concerns expressed and that the Bill will receive broad support from all sides of the House. I again thank all Senators for their support and new and refreshing ideas.

Question put and agreed to.
Bill put through Committee, reported without amendment, received for final consideration and passed.