I move: "That the Bill be now read a Second Time."
I am delighted to introduce the Adult Safeguarding Bill 2017. I welcome visitors from the National Safeguarding Committee, the Support and Advocacy Service for Older People, SAGE, and my sisters from the south in the Public Gallery who are here for this occasion. In many ways this Bill is greenfield site legislation that I hope will become an important piece of the architecture of our legislation on rights, care and protections of people. The Bill's goal is to provide safeguards from abuse or harm, in particular for those who may be unable to protect themselves. It can be thought of as Children’s First legislation for adults at risk. It is important to note that this legislation is for all adults because at some point or other in all of our lives we may be at risk of abuse or harm.
It is unfortunately true that many adults across the State are abused and harmed every day. This harm and abuse comes in many forms and from many quarters. Some of those who are abused and harmed have no voice of their own and no one to voice their concerns. Some are physically unable to reach out for help while others lack the capacity to do so. It is very likely that at some point in all of our lives we may be at risk of harm or abuse. It may not happen today or tomorrow but some day we may be the adult with dementia who is financially manipulated, or the person post stroke who can no longer speak, or a person with an intellectual disability who is taken advantage of, or the person whose adult son or daughter has turned their loving home into a personal prison. In yesterday's news reports we saw the horrific Armagh so-called house of horrors case where a vulnerable woman was abused for years on end. This legislation seeks to provide protection for people in these and many other situations. The 500,000 people aged 65 or over, people living in their own home, people living in institutions, people in nursing homes, people with mental ill health, people with autism and people with disabilities, both mental and physical, are particularly at risk of abuse and require robust safeguarding.
While we do not have comprehensive statistics on abuse and neglect, the data that exist paint a very bleak picture. The National Study of Elder Abuse and Neglect from 2010 estimated that 10,000 older people are mistreated or neglected each year, with 6,000 cases of financial abuse. That study also showed that for many people who are financially abused, their only income was their State pension. Given that the State rightly pays more than €7 billion in pension payments and more than €3 billion in illness, disability and carers' payments, the scale of financial abuse is potentially massive. Dr. Amanda Phelan of UCD estimates that 32,000 older people were abused in the past 12 months - a staggering figure. We know form international studies that people with dementia are especially prone to abuse in the community, with rates as high as 55%.
The need for a legislative provision to safeguard adults from harm and abuse has been highlighted several times by various bodies over the past six years beginning with a Law Reform Commission report in 2011. In 2014, RTE's "Prime Time Investigates" programme exposed high levels of abuse of adults at risk in Áras Attracta, Swinford, County Mayo. This investigation heightened awareness of abuse of adults nationally and the need for comprehensive action and reform. Following the RTE investigation, the HSE published its safeguarding policy, Safeguarding Vulnerable Persons at Risk of Abuse National Policy & Procedures. This safeguarding policy outlines a number of principles to promote the independence and rights of adults who are vulnerable and outlines the procedures to be followed if there are concerns of abuse or neglect of a vulnerable adult. The policy provides for a number of structures to be set up to support the safeguarding agenda. This includes the National Safeguarding Committee, on which I once served.
In July 2016, the Health Service Executive, HSE, published the independent review of the Áras Attracta case. This review called for the HSE safeguarding policy to be put on a statutory footing. It noted:
The HSE's safeguarding procedures are now being put in place and activated throughout Ireland. In order for these procedures to have teeth, however, they are required to be placed on a statutory basis. This would ensure that they are fully implemented.
Similarly, the Health Information and Quality Authority, HIQA, in its submission last year to the Oireachtas Select Committee on the Future of Healthcare noted:
We believe that now is the time to introduce safeguarding legislation to protect at risk adults from abuse and neglect. While national safeguarding protocols are in place following recent high-profile revelations of abuse, these do not go far enough to ensure the safety and rights of vulnerable people.
Last year the National Safeguarding Committee, chaired by Patricia Rickard-Clarke, formerly of the Law Reform Commission, published its strategic plan 2017-2021 which sets out a commitment to "initiate conversations with Government and Oireachtas Committees on the development of legislation to include adult safeguarding". In launching the report, Ms Justice Laffoy said there is a "significant gap in adult safeguarding". She also noted the need to "enshrine in law the rights of vulnerable people".
Safeguarding legislation has been also called for by a range of other stakeholders including non-governmental organisations, NGOs, academics, Oireachtas Members, including Deputy Mary Butler, front-line workers, concerned family members, people in the community and self-advocates. It is clear that the status quo is not working. The HSE policy does not go far enough. Staff working in this area have said they need powers to go with the responsibilities of the role and legislative backup to protect adults. There are also clear conflicts of interest. The HSE has too many roles, some of which are conflicting. It acts as the commissioner, funder and provider of services as well as police and protector. People with concerns often have nowhere else to go, no clear pathway, often resorting to the Committee of Public Accounts as whistleblowers as a last resort. That is why I have included an independent arm's length body in this Bill. In my consultations on the Bill I was alerted to many different cases of abuse. I was told about one older woman who was admitted to hospital for an extended period and could no longer pay her bills as normal at the post office. Instead she gave her bank details to a family member to pay her bills. When she examined her account after she left hospital, she found that someone had set up a range of direct debits to pay their own bills from her account. I was told about an elderly woman living with her son who had alcohol and addiction problems who was sometimes abusive but whom she loves, experiencing serious difficulties.
The Grace case, which we have dealt with in detail in recent weeks, highlights more than others why we need legislation like this. The case, which involved an adult with intellectual disabilities, highlighted systemic and systematic failures to act to prevent abuse, conflicts of interest, poor separation of duties and responsibilities, and a lack of clarity about what to do. With Grace, her life and her welfare fell through all the cracks in our current system. The proposed legislation is a framework to protect people like Grace with clear definitions of abuse and obligations on those who could and would have acted. It creates an arm's length, independent body to prevent and investigate cases of abuse and harm.
The goal of this Bill is to ensure cases like Grace, Áras Attracta or many others never happen again by changing culture and mindsets, with people recognising what abuse, harm and neglect are and having zero tolerance of them. It should act as a deterrent and put people off committing abusive acts, with sanctions for those who fail to act. It sets out clear pathways for action so that no one can say they did not know or did not know what to do.
To that end the Adult Safeguarding Bill 2017 does two main things. Part 3 provides for mandatory reporting by certain professionals and others where an adult has suffered abuse or harm, is suffering abuse or harm, or is at risk of suffering abuse or harm. Part 2 establishes a national adult safeguarding authority that will be required to respond effectively if significant concerns of abuse or harm are reported. The authority will have the power to investigate, including the power to enter. It will also have powers to direct the HSE and others to provide additional support or assistance if required. This was much emphasised by those working on the front line. It will also be able to appoint an independent advocate, a key protection especially endorsed by the self-advocates I met in preparing this Bill. It will also provide education, training and public awareness about what risk looks like and about adults at risk. It will promote standards in the safety and quality of services, provide guidance to State bodies and the Minister and provide information directly to adults at risk of abuse and harm via a helpline and website. This ability to self-refer is an important aspect of the Bill.
The Bill has a human rights focus and defines abuse and harm widely. These definitions are set out in Part 1. "Harm" includes assault and sexual and financial abuse. "Abuse" includes:
act, failure to act or neglect, which results in a breach of a person’s constitutional or legal rights, physical and mental health, dignity or general wellbeing, and may include ill-treatment, intimidation, humiliation, overmedication, withholding necessary medication, censoring communications, invasion or denial of privacy, or denial of access to visitors.
Passing this legislation will ensure we make good on our commitment to Article 16 of the UN Convention on the Rights of Persons with Disabilities which states:
States Parties shall take all appropriate legislative, administrative, social, educational and other measures to protect persons with disabilities, both within and outside the home, from all forms of exploitation, violence and abuse, including their gender-based aspects.
The proposed legislation is informed by the following principles: the promotion of individual physical, mental and emotional well-being; the right to assistance, support and an independent advocate; the right to protection from abuse and neglect; interventions in people's lives must be necessary and proportionate; and respect for people's autonomy in decisions and interventions that affect them. The Bill, I hope, strikes a balance between the right to autonomy and the right to protection from harm. I have been working on this Bill for nine months. In that time I have been advised and assisted by staff within the House and by more than 40 stakeholders from a wide range of backgrounds, including NGOs, academics, front-line workers, families and people who will receive additional protections if this legislation passes.
In particular I thank Patricia Rickard-Clarke, chairperson of the National Safeguarding Committee, for all her advice and guidance, and the self-advocates and individuals who for one reason or another would gain protections from this Bill and who informed the content and helped shape it. I also thank Dr. Sophia Carey from the Library and Research Service, Melissa English and David Hegarty from the Office of the Parliamentary Legal Adviser, the barrister we worked with, David Dodd, and of course Padraig Rice for his invaluable support with this Bill and other work. I also thank my colleagues in the Seanad for the political support I have received for the Bill, in particular, Senators Buttimer, Clifford-Lee, Higgins, Bacik, O'Donnell, Boyhan, Black, Dolan and Ruane who all signed the Bill, and others who expressed their support, including Senator Conway-Walsh. It is rare to see such levels of cross-party support and I sincerely thank everyone for that.
Finally, I thank the Minister for Health and his officials who have been very generous with their time and advice. I am encouraged by the Minister's support and commitment to progress the Bill. It is urgent legislation but I understand it is complex, involves several Departments and requires some more development to become a long-term piece of our rights and care architecture. I am grateful, therefore, for the Minister's suggestion that we take this Bill forward to a form of pre-legislative scrutiny and I ask for a commitment today that a version of adult safeguarding legislation will be enacted within a year. I ask fellow Senators to pass this Bill tonight to ensure we can progress it to the next required stage.