Joint Committee on Disability Matters díospóireacht -
Wednesday, 21 Feb 2024

Safeguarding: Safeguarding Ireland

An Cathaoirleach

We have received apologies from Senators Clonan and O'Loughlin. Today's meeting is about safeguarding. On behalf of the committee, I welcome from Safeguarding Ireland: Patricia Rickard-Clarke, chairperson; Annmarie O’Connor, programme manager; and Ronan Cavanagh, communications and public awareness.

Before we begin, I have some housekeeping matters. Witnesses are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person or entity outside the House in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be damaging to the good name of a person or entity. If a statement is potentially defamatory in relation to identifying a person or entity and witnesses are directed to discontinue their remarks, it is imperative they comply with any such direction.

Members are also reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person or entity outside the House in such a way as to make him, her or it identifiable. Members are reminded of the constitutional requirement that they must be within the confines of the Leinster House precinct to contribute remotely via Microsoft Teams in the public meeting. I ask members to let us know before they make their contribution if that is the case.

Without further ado, I call Ms Patricia Rickard-Clarke to make her opening statement.

Ms Patricia Rickard-Clarke

We welcome the invitation to appear before the committee today. I am the chair of Safeguarding Ireland and I am joined by my colleagues Annmarie O’Connor and Ronan Cavanagh.

The national safeguarding committee was established by the HSE in December 2015 in the aftermath of the investigation of the adult abuse issues within the Áras Attracta facility to bring together the views and perspectives of a multi-sectoral group on how the issue of adult safeguarding could be addressed in health and social care services in Ireland under an independent chair. In 2017, the national safeguarding committee evolved into an independent entity, National Safeguarding Ireland CLG, which is a registered charity trading as Safeguarding Ireland.

Safeguarding Ireland’s primary objectives are to promote safeguarding of adults who may be vulnerable; protect them from all forms of abuse by persons, organisations and institutions; and develop a national plan for promoting their welfare. This is achieved by promoting intersectoral collaboration, developing public and professional awareness and education, and undertaking research to inform policy, practice and legislation in the Republic of Ireland. The board of Safeguarding Ireland brings together individuals with extensive experience and expertise in legislation, regulation, policy and practice in the areas of health, social care and finance. Its work is informed by, and delivered in collaboration with, a national safeguarding advisory committee. This is a very significant grouping comprising almost 40 bodies from across a very wide range of sectors and organisations with an extensive national reach.

Under its current strategy, Safeguarding Ireland has focused on three main objectives: the promotion and pursuit of the introduction and enactment of adult safeguarding legislation; the establishment of an independent overarching national safeguarding authority; and raising public and organisational awareness of issues of abuse, neglect and exploitation and of the need for a rights-informed approach to adult safeguarding issues. To support these objectives, in 2022, Safeguarding Ireland published the most comprehensive overview and analysis of adult safeguarding issues in Ireland to date in a discussion paper called Identifying RISKS Sharing RESPONSIBILITIES: The Case for a Comprehensive Approach to Safeguarding Vulnerable Adults, which described the nature of adult abuse in Ireland; the patchwork of legislation that exists to protect people and the deficits in what is known about adult safeguarding; the current policy and legislative response; and importantly, the absence of an overarching governing body to ensure there is accountability, collaboration and coherence across all sectors.

There are many gaps and they include adult safeguarding legislation, social care legislation, and the absence of a uniform regulatory framework covering legislation, policies, accountability and enforcement across all settings. Others include legislation on deprivation of liberty to include a place of care; regulation of home care services; legislative underpinning for the practice of independent advocacy in Ireland; multidisciplinary and cross-sectoral policy on self-neglect; guidance and regulation on data sharing; a comprehensive cross-sectoral framework for data collection on abuse of adults; and departmental and agency policy and related accountability procedures and training for staff outside of health and social care sectors, which applies to all Departments and agencies providing services to adults who may be at risk of harm or abuse. The requirement for policy also extends to the private sector and, in particular, to the providers of essential services such as financial services and utilities. Also necessary is the need for the recognition and criminalisation of coercive control in non-intimate partner relationships; access to legal aid and-or representation; and a single point of contact for any adult who is at risk or who has experience of abuse.

There are vast gaps in the shared and co-ordinated response that is required to effectively empower people to exercise their human rights and to protect themselves, and in the collective national response to preventing harm and abuse.

Despite growing awareness, a culture that is dismissive of certain forms of abuse, that trivialises other forms of abuse and that plays down the human rights of many adults in vulnerable circumstances persists in Ireland. Deep cultural change is requited. Regrettably, it is still the cases of abuse suffered by individuals such as Emily that bring the greatest degree of focus and attention. There have been some positive developments. The big positive is the commencement in April 2023 of the assisted decision-making capacity legislation. In January 2023, the Department of Health re-established the protection of liberty safeguards expert advisory Group. In June 2023, the HSE CEO, Mr. Bernard Gloster, announced the appointment of an external expert to conduct a high-level review of the HSE safeguarding policy procedures and structures and to advise on possible options for the future of safeguarding. The report is expected to issue in the coming weeks. In January 2024, the Minister of State, Deputy Butler, launched the Department of Health's public consultation on policy proposals on adult safeguarding in the health and social care sector, but it is limited to that sector. It is expected that the Law Reform Commission will publish its report on irregularity framework on adult safeguarding imminently.

Safeguarding Ireland cannot anticipate what the landscape may look like when these important policies and reports are published but we are clear that the creation of an adequate legislative foundation is crucial if Ireland is to have a fit-for-purpose safeguarding capability to both address the gaps and deficits I have outlined and to ensure compliance with Article 16 of the UN Convention on the Rights of Persons with Disabilities, where the State has an obligation to accommodate all people with disabilities. The current organisational response is far too fragmented and far from cohesive. There is a need for a national body that can address the issue in a comprehensive and all-encompassing manner and compelling interagency co-operation and collaboration in identifying and responding to abuse of adults at risk. An independent body with overarching responsibility for regulating adult safeguarding generally is a key requirement. A new statutory regulative authority should have at its core the overall goal of zero tolerance in our society of adult abuse, which will be emphasised through the four key pillars which we have stated in our discussion paper, namely, prevention, protection, prosecution and policy co-ordination. I thank the Chair and we are quite happy to answer any questions members may have.

An Cathaoirleach

I call on Deputy Feighan, who is substituting for Deputy Higgins.

Deputy Frankie Feighan

I thank Ms Rickard-Clarke, Ms O'Connor and Mr. Cavanagh for coming in today. We appreciate the great work Safeguarding Ireland has done since it was established following issues in December 2015. I have a few questions. The Irish Association of Social Workers has highlighted that 51,000 concerns about the abuse and neglect of adults have been reported to the safeguarding and protection social work teams since 2015. However, it seems unknown as to how many of these relate to people with disabilities. We have also established that An Garda Síochána cannot provide figures about the rate of abuse and neglect of residents in nursing homes or disability centres reported to it. Can the witnesses discuss the under-reporting of safeguarding issues and immediate action to improve and standardise reporting, as well as the lack of redress?

Also, what measures are needed to ensure that An Garda Síochána can provide figures about the rates of abuse and neglect of residents in nursing homes or disability centres reported to it? At this committee Professor Brendan Kelly stated that Ireland is failing to safeguard rights for people with severe mental illness such as schizophrenia and bipolar disorder and that these failings while not deliberate, are widespread, systematic, predictable and preventable. Can the witnesses discuss, in terms of the medical versus social human rights model of disability, what safeguarding provisions would look like with regard to social and medical well-being? Is there a need to reform the Health Act 2007 and associated regulations in parallel? That Act contains a narrow definition of "designated centre" that limits regulatory protection for people with a disability to the confines of the centre's footprint.

Ms Patricia Rickard-Clarke

As regards the Irish Association of Social Workers and the 51,000 concerns reported to the HSE safeguarding teams since they started collecting data, the truth of the matter is that they are limited to the health and social care services. It does not extend even to other HSE facilities, acute hospitals or whatever. We have no national collection of data in relation to adult safeguarding,which is one of the big gaps. Counter to that, in respect of the sharing of information where issues arise, again there is huge confusion abut the possibility of sharing. The GDPR is raised as a defence. In fact the GDPR itself provides that people can share information where the vital interests of the person are at stake, etc. Indeed, we require regulation under the Data Protection Act 2018 as again, in the public interest data can shared. The big gap is that we have no national collection of data across all sectors. As I say, in the HSE, that data is limited.

Coming to An Garda Síochána, we in Safeguarding Ireland have worked with An Garda Síochána over the last number of years. An Garda Síochána does not collect information. Moreover, I know from some of the advocacy bodies that if a person lacks decision-making capacity, that is used as an excuse not to pursue issues that arise in relation to his or her rights. Recently, responsibility for adult safeguarding in the Garda Síochána was transferred to the protection teams and we are hoping for a development on that. We are also hoping that the police and community legislation coming forward will have provision and will develop a need for the collection of data and a process and policies under that.

On the issue of the rights of people with mental health difficulties in the context of medical versus social rights, this is a huge issue even within the assisted decision-making capacity legislation. That legislation is very clear that it is a social model to respect a person's rights to exercise their individual human rights and yet in many cases, the disability tag appears in terms of the medical model. If a person has dementia or has an intellectual disability then rather than, as the Act provides, there being a clear presumption of capacity, straight away people revert to an assumption that the person lacks capacity. So there is a lot of cultural shift to occur in relation to a lot of these matters. As for whether there a need for a reform of the Health Act, the Health Act itself provides that the HSE has a function to protect and promote the welfare of all individuals but we need specific adult care legislation and adult safeguarding legislation. Care legislation would be, as in other jurisdictions, promoting the well-being of individuals, putting in systems and requiring organisations both public and private to have systems in place to promote well-being, to prevent and reduce abuse and to give information to people and advise them as to where they can get assistance. That is the care element and the social care element. Obviously with adult safeguarding you need to take steps to enter into premises, to issue no-contact orders or whatever to protect very vulnerable people if that is necessary and that is where we need the adult safeguarding legislation. The Law Reform Commission is due to publish a very detailed report and our understanding is that report will propose two Bills, one on the criminal law side and the second on the civil law side. It will set out proposals in terms of the regulatory framework we should have in this jurisdiction to deal with adult safeguarding. It is not just a matter of amending the Health Act as we need comprehensive adult safeguarding and care legislation to encompass all sectors.

Mr. Ronan Cavanagh

Could I add a small bit of data to the Deputy's question?

In 2019, Safeguarding Ireland carried out a poll of a representative sample of adults asking them about their experience, or an experience they had witnessed, of adult abuse. Some 10% of adults said that they had either experienced or witnessed adult abuse. This adds up to approximately 400,000 cases. The most recent HSE annual report from its safeguarding office has in excess of approximately 13,000 reported cases of suspected adult abuse. This shows the gap between what is reported to the HSE services and what the reality may be. This raises the point that there is a need for broken-down figures from An Garda Síochána and that is something that we do not currently have. A national safeguarding authority would be the place in which all the different contexts and suspected cases of adult abuse could be co-ordinated. There would be a truer figure through a national co-ordinated structure.

Deputy Dessie Ellis

I thank Mr. Cavanagh for his input. As I listened to him speaking about the huge gaps, and when I looked at those gaps, it occurred to me that there are a lot of areas in question and there is a lot to do, whether that is through legislation, the HSE or An Garda Síochána. He said that abuse, exploitation and neglect of adults are happening on a daily basis and that is fairly clear. The area of online abuse occurred to me. I know this discussion is around adult abuse and this is generally an issue associated with younger people, but I would like to know whether Safeguarding Ireland is encountering much bullying and coercion in emails, etc. Is that a big issue for older people? I am curious in this regard.

How well advanced are we in addressing mental health issues with the Mental Health Commission? I am aware of positive developments such as the Assisted Decision-Making (Capacity) Act 2015. Mr. Cavanagh outlined a number of areas where there are positives. While some advancements are being made, I think there were a lot more negatives than positives.

In the estimation of Safeguarding Ireland, how big and serious is the risk of abuse in organisations and in congregated settings, rather than community-based places or houses? Mr. Cavanagh said that Safeguarding Ireland has three main objectives and that it has published a comprehensive review and analysis of them. I am curious about that. Can he share with the committee some details of how that it is going?

In general, where is the abuse mainly focused? Is it in the family? I know that it occurs within nursing homes and that it can be found across a number of areas, but it is under-reported in people with disabilities, from what I can see. How badly under-reported is it? I am aware that there was an investigation into one particular home, Áras Attracta, but are there other places of concern? Are there a number of places with which we have serious concern? I am curious about that.

Access to legal aid and representation is a significant issue for people, especially those who have issues with capacity. Is that working? Is the message getting out to people?

Ms Patricia Rickard-Clarke

I will answer a few of those questions. I may ask my colleague, Ms Annmarie O'Connor, to come in on specific issues.

As the Deputy asked about particular areas of abuse, I wish to say that Safeguarding Ireland does not provide any service; it is a body looking for the enactment of legislation. Forty organisations feed into it, including the National Federation of Voluntary Bodies, Inclusion Ireland and the Mental Health Commission. All of those are members of our national advisory committee. Financial abuse is high on the list of types of abuse in our paper and in the HSE's figures. Coercive control - controlling behaviour for financial, sexual or physical abuse - permeates all other types of abuse. It is a huge issue and we identify it in our paper. It is noted that Safeguarding Ireland assisted with drawing up the amendment to the Non-Fatal Offences against the Person Act 1997 that was provided for in July 2023 under the Criminal Justice (Miscellaneous Provisions) Act 2023. The Minister accepted that it was necessary to expand coercive control wider than how it is contained in the domestic violence legislation. This is an urgent matter that must be dealt with.

The levels of abuse are another urgent matter. An issue that arises is the deprivation of a person's liberty. There is specific legislation for people who commit crime; they have a right to a fair trial and to legal representation, etc. There is detailed mental health legislation for people who are involuntary detained. However, there is no detailed legislation covering people who are put into places of care or into congregated settings where they do not want to be. I refer to respecting their individual rights, their will and their preference on these issues. The deprivation of liberty is a constitutional matter under the Assisted Decision-Making (Capacity) Act 2015. There is no process prescribed by law as is required by the Constitution, the European Convention on Human Rights and the UN Convention of the Rights of People with Disabilities. That is a big gap. This is an urgent matter that needs to be dealt with because at the moment, there are delayed discharges for older people and for nursing homes.

The Circuit Court does not have jurisdiction to make orders, to put people in a place or to detain them where they do not want to be. An application to the High Court is needed. Therefore, there is an application for a person who lacks capacity going to the Circuit Court and a second application must be made to the High Court to exercise its inherent jurisdiction. An inherent jurisdiction means that there is no specific statutory prevision and that the High Court can exercise its discretion to make such orders. I wished to mention the whole question of financial abuse as it is widely under-reported.

As for the Deputy's question on who are the main perpetrators, the figures from the HSE indicate that almost 80% are relatives and family members. There are high levels within the family - much higher than in community and care settings and such.

Ms Annmarie O'Connor

Deputy Ellis mentioned online abuse. As public services and essential services such as banking and financial services become increasingly digitalised, people are required to live their lives online. Without a doubt, adults who may be at risk of harm are being targeted by people who are seeking to profit from their situation. With regard to financial abuse, as Ms Rickard-Clarke said we do not provide a service directly to the public but we get a lot of queries from the public and we interact with a wide range of organisations. A risk of financial abuse is most definitely created where people find it difficult to engage with services, financial services in particular, and do not have the assistance of a third party. Safeguarding Ireland had a high degree of involvement over the past year around the issue of the banks exiting the market and people having to transfer their accounts and open new bank accounts. A lot of people experienced difficulty in setting up new accounts, etc. While the banks were conscious of the risks for certain people and provided a lot of support, it exposed the issue of people struggling to use online services autonomously. This undoubtedly creates a risk of financial abuse and of other types of online abuse.

It relates not just to the risk of their money being taken from them but also their personal data and of all kinds of other abuses. We are increasingly aware of the risk of online harms but I am not sure we are aware of how those harms occur, who is targeted and what the preventive measures required are. We would certainly say that services need to be designed in order that people can use them safely. There is a lot of emphasis, as members are probably aware, on financial and digital literacy and so on. While they serve a purpose, we need to have services that people can access safely. My colleague Patricia Rickard-Clarke and I sometimes meet adults who may have intellectual disabilities or other disabilities and they are very conscious of the risk of abuse. In some cases, they are quite fearful of the harms of engaging with digital services. If we are to digitalise - and we are digitalising - we need to place a greater focus on the harms that can people can be exposed to. It is not all about teaching people about the risks as it also is about taking the risk out of the services.

Deputy Dessie Ellis

My own experience of the financial pressure people are put under is of people selling their homes and ending up homeless. It happens a lot more than people realise. They are put under awful pressure from family to sell the house and distribute the money among the family and then they end up in a terrible situation. I agree with Ms O'Connor that the financial aspect is major.

Ms Patricia Rickard-Clarke

That is where the Assisted Decision-Making Capacity Act is extremely important. I have seen it in the courts where the family is making the application to sell the house in advance. We now have Decision Support Service oversight so if a court order is made to appoint somebody to deal with somebody's property, it must be used for the benefit of that person. Under the previous legislation, say during the time of the joint powers of attorney legislation of 1996, as there was no oversight of attorneys, there was a lot of financial abuse including attorneys again not paying for care or collecting the pension of the person concerned but also selling a person's property. Under the new legislation, the Decision Support Service has a specific function of oversight in relation to any of the decision's supporters who are appointed under the Act. It will look when they are appointed for a schedule of assets and income, including potential income, and then will overview that on a periodic basis. That is a huge plus in the new legislation.

Another thing I will mention in respect of selling homes is in terms of equity release schemes about which I am hearing ads at the moment. While some people may want money to be released, before the recession a lot of older people assisted people such as their sons or daughters and ended up without a home over their heads so we have to be very careful about that. Obviously it is an option people have and they have the right to exercise it but it is a risk that people must be aware of. The other issue regarding entering into an equity release scheme is that if you subsequently apply for the fair deal, that is a first charge and you may not be entitled to a fair deal loan. There are issues there. We have raised them with the Central Bank as well to ensure all of those entities are properly regulated and that there will be a warning put in the forthcoming consumer protection code to highlight some of these issues.

An Cathaoirleach

As I read it and as I see the schedule in front of me, the Dáil is suspended until 6.10 p.m and we are into the voting block at 6.10 p.m. The voting block will probably take about 30 minutes. I do not know what the motion was on Thursday but there are two motions tonight so that will take about 30 minutes. We will take one speaker and then we will suspend and come back when the Dáil vote starts. Is that agreed? Agreed.

Senator Erin McGreehan

I welcome the witnesses. We speak about safeguarding issues across a lot of committees in this house and more so in this committee. As safeguarding has been a topic of huge importance to us over the past few years, it is great to have the witnesses here. Adult safeguarding legislation is a programme for Government commitment and we are looking forward to that. My question is on the current legislation that is in support of protecting vulnerable adults. When we had HIQA in here a couple of years ago, its representatives highlighted that there had been 143 sexual assaults against residents in care settings. We know we have legislation on reporting and it is an offence not to report. I do not believe anyone has been brought up on that offence as of yet and in terms of people who are charged with safeguarding adults, we have Safeguarding Ireland, HIQA and the law. When people are failing and withholding information they have on particular situations, what is the role of Safeguarding Ireland in making sure the existing legislation is enforced and that people understand the existing legislation? As for children, there is the mandatory reporting and since the enactment of the Criminal Justice (Withholding of Information on Offences against Children and Vulnerable Persons) Act 2012, it is an offence to withhold. Then we had 143 sexual assaults between 2015 to 2022. We had the calamity in Donegal where absolutely disgraceful occurrences happened that have ruined individuals lives and people knew about it. Where does the HSE stand and where does Safeguarding Ireland stand on the good legislation we have not being implemented?

Ms Patricia Rickard-Clarke

Safeguarding Ireland as an organisation is a voluntary board. We do not have any function in relation to safeguarding adults. Moreover, we are not part of the HSE but are an independent body. Since our establishment, we been arguing for the detail the Senator is looking for and posing questions on all of that. In terms of the current legislation and protecting people, the other issue is that HIQA regulates designated centres and nursing homes but has no current remit in terms of dealing with individual issues. That is a big gap which we hope it will fill shortly. Also there is no regulation of home care services, for example, if it is happening in the community. It is an absolute disgrace that while there is legislation there and while there is an obligation and it is an offence if you do not report, there has been no reporting with many of these issues. It comes down again to education and training and the fact that we as a country and a culture have not had the debate around adult safeguarding. We have only begun to do so in the last few years but when trying to convince people this is really critical and that safeguarding is everybody's business, lots of people and organisations do not see that. We need clear adult safeguarding legislation, a critical review of cases where things happen by an independent authority. The HSE should not be investigating things within its own service. It is really important that we have such an independent authority, that they investigate complaints and that people know that is the authority to which they have an obligation, under various sectors or whatever, to report.

Mr. Ronan Cavanagh

Briefly, if I could return to a point made by Deputy Ellis and to reinforce what he was saying, we do a lot of polling on experiences and pre-Covid, online abuse was the fifth most common type but it was the third most common type after Covid, which I think is no surprise. People think of sexual abuse but psychological, online and emotional abuse are more common.

Part of the brief of Safeguarding Ireland is to raise public awareness around the very issue the Senator raised around reporting. We found that about a quarter of people are not sure where to go or who to report to if they have a safeguarding concern. We undertake an annual campaign called Adult Safeguarding Day. In 2022, we had a very clear message that if there is an immediate or serious concern, people should report that to the Garda, and there is nowhere else they should go with a serious concern than to the Garda if somebody is at immediate risk of harm. If there is an ongoing complex issue, people should report that to the HSE safeguarding teams. We try to continuously build greater awareness among the public via social media, general media and local radio interviews. Granted, there is still an ongoing need for further understanding of how and where to report adult abuse.

Senator Erin McGreehan

It is soul-destroying, as I am sure the witnesses will agree. Hopefully, they did not think I was suggesting that Safeguarding Ireland was the HSE or was established by the HSE. The HSE and HIQA are potentially breaking the law here, and we are all sitting with it. I find that very depressing and concerning given that we have legislation, although we need more legislation and I am one of the greatest advocates for it. The witnesses have been working in this area for a lot longer than I have. We talk about training. HIQA is the body that we would hope is trained. The HSE is the body that we would hope has trained staff who are our paid servants. How do we all reconcile this? We are all on the same side here. It is damning.

Ms Patricia Rickard-Clarke

We need a system working from the ground up. Some of the reporting does not happen early enough. It is really that whole education around safeguarding at every level and then, where the thresholds come in, mandatory reporting, or hybrid reporting in certain circumstances. Hopefully, the Law Reform Commission will have detail on what should be reported mandatorily and what are the hybrid elements. Again, looking at Australia and other countries, there can be a lot of reporting that is not related to abuse and, therefore, the system gets clogged up. It is very important that we have a clear and efficient system for reporting that works, as I said, from the ground up.

Some people are afraid in terms of staffing and all of those issues, so we have to be very clear about sharing information and intersectoral collaboration. In some areas, one organisation may be aware of abuse and it should be necessary to share that either with the Garda or another organisation, where a person is suffering abuse in different contexts.

An Cathaoirleach

A vote has been called in the Chamber so we will suspend. I presume it will be approximately half an hour before we can resume.

Sitting suspended at 6.14 p.m. and resumed at 7.19 p.m.

An Cathaoirleach

We are back in public session. Our next speaker is our Vice Chair, Deputy Tully.

Deputy Pauline Tully

I thank the witnesses for their attendance and presentation earlier and for waiting such a long time for all those votes. I am looking at some of their objectives and some of the things they have identified as being positive developments. A number of reports are due, including the results of the review from Mr. Bernard Gloster of the HSE in a couple of weeks, the Minister of State, Deputy Butler's proposals and that of the Law Reform Commission. Are the witnesses hopeful that the outcome of all those reports will lead to legislation for the adult safeguarding legislation and the establishment of the independent national adult safeguarding authority? I want to pick up on a number of issues.

I note people have already expressed the concern that the Garda does not seem to have the numbers of complaints and I wonder why that is. I attend my JPC meeting in my locality and they will have a breakdown of different types of crimes they deal with. This is not included and I wonder why. We hear a lot in this committee about data collection regarding disability issues and that, unfortunately, it is insufficient at best and absent much of the time. It is hard to plan without proper data. Why is it the case the Garda does not have the numbers?

It was mentioned that some forms of abuse are often dismissed or trivialised. What type of abuse is that? Is that more in places such as nursing homes or institutions of some sort rather than, as was said, in the family, where much abuse occurs as well?

Deprivation of liberty was mentioned. I have had occasion to deal with families with, for example, a young adult of 18, 19 or 20 years of age who is often non-verbal, usually autistic, and there may be behavioural issues out of frustration and not getting the proper supports. When the families reach out looking for support, the young person is put in an institution, usually an unsuitable one. Sometimes it is a hospital, a mental health institution or a residential facility, and they are often overmedicalised. I think it is called pharmacological restraint. The families cannot go anywhere to get this dealt with. If they try to make a complaint, they are more or less told that the young person is an adult. The young person is non-verbal though. Is that something the witnesses are aware of or have received complaints about? Do they foresee this being covered by safeguarding legislation?

I attended a presentation earlier today on restraint and seclusion in schools. I know that is children, not adults, but unfortunately much abuse is happening within our schools as well, especially among children with disabilities. I think more than one third of them have been secluded, physically restrained or medically restrained. Different forms of restraint are being used. It is just shocking. It is happening in our schools where there is safeguarding and there should be somebody there to report this behaviour to. It is still happening on a large scale. There is a need for guidelines or regulations on it. It is probably, in a way, not surprising that it is happening among adults as well. It needs to be highlighted and prevented.

On whistleblowers, you will often come across people working in a nursing home, for example, where they witness abuse and report it. They do the right thing and then they end up being the person who is victimised by other staff. Do the witnesses find there is sometimes a culture within certain organisations of overlooking abuse and then backing the person perpetrating the abuse? It could be out of fear of that person, who might have a bullying attitude.

I will leave it at that.

Ms Patricia Rickard-Clarke

I will attempt to answer those questions. On the objectives in terms of the various publications that are due, the HSE has an external expert to look at that. We spoke to Jackie McIlroy, who is the external expert, and gave our views on the need for that. The Deputy asked a direct question whether we think that will make changes and lead to adult safeguarding. We hope the CEO is conscious of the need for developed systems and efficiencies within the HSE with regard to adult safeguarding. There are gaps, as we said before. It is very limited at the moment. Some safeguarding teams go into private nursing homes and others do not. There are gaps in dealing with self-neglect and other issues. There are quite a number of gaps. Again, they are not in acute hospitals and things like that. I think the CEO is aware of those issues and it is hoped the report will identify what needs to be done and updated.

On the Law Reform Commission report, we hope to see a recommendation for a national safeguarding authority. It is absolutely key to set the scene. The whole composition of that authority is very important. We will be asking the committee to pay specific regard to that need and ensure the legislation provides that the authority has teeth. We understand the Law Reform Commission will be making recommendations about applications to court for right of entry, no contact orders and things such as that, but we need that authority with oversight on all of those issues and to have HIQA, the HSE, the Decision Support Service and various regulatory bodies accountable to it. It should also have representation from all sectors and quite a number of detailed departments. That intersectoral, interdisciplinary, multiparticipation is important to get across the spectrum.

The other issue we have raised a couple times with the HSE is that there is no 24-hour call service for people in difficulty. We in Safeguarding Ireland have got calls out of hours. We need a national call line for people in difficulties. That is a huge gap. Sports bodies, voluntary bodies and other bodies not within the social care sector contact us. There is a huge gap there.

Those are the issues across those sectors. I will leave it to Mr. Cavanagh to answer the question on the Garda figures.

The Deputy asked about abuse being trivialised. We did a survey about 18 months or two years ago and asked the question, “Does another person have a right to make decisions on behalf of a person who is old and frail without their consent?” Some 57% of the Irish population think you can do so without the consent of the person, even if they have capacity. In other words, decisions are made on behalf of people, particularly people in vulnerable circumstances or people with disability. There is a higher lack of respect for their rights. Regarding financial abuse, families think they can just manage the money or decide. They think they can pick up the pension or disability benefit and it is family money, not that person’s money. All of those personal decisions are very important. That is a cultural thing as well. It goes back to asking the person where they want to be and whether they wish to be in that group home or whatever. It is important their needs and risks are all assessed with regard to that.

The Deputy is absolutely right. We in Safeguarding Ireland have just commissioned a piece of research on peer-to-peer abuse, which has arisen quite a number of times. We spoke to the National Federation of Voluntary Bodies, which said behavioural issues are because people cannot express themselves, are unhappy and all of that, so the Deputy is absolutely right. Safeguarding and proper care legislation should pick up many of those issues. I think a lot of resources are spent going around in circles doing the wrong thing rather than putting resources into a proper, effective system of adult care and safeguarding and the prevention of abuse. We should be doing that rather than waiting for the crisis and spending huge amounts of money on legal proceedings or tribunals and all the rest without starting at the beginning and seeing how we can put in preventative and safeguarding measures. That is very important.

On whistleblowers, we need it clear that safeguarding is everybody’s responsibility. I referenced earlier a system internally from bottom up and top down. There needs to be a very open system. We are aware that, say, nursing assistants are afraid to report up the line. There are nursing assistants who get very little training. There are huge issues with that. That leads to lack of reporting and even being afraid to report. Many people who are the victims of abuse or lack of safeguarding are afraid because they may be dependent on other people. It is up to the rest of us to watch out for that, recognise it and raise awareness about it.

Mr. Cavanagh might talk about some of the figures.

Mr. Ronan Cavanagh

No problem at all. Obviously, Garda figures on crime have come out. The issue I was referring to is that, on the one hand, there are HSE safeguarding office figures that report annually on cases of alleged abuse, which are broken down into the different categories I referred to earlier, such as online abuse, emotional abuse or psychological abuse, which are the main types.

On the Garda figures, what we promote is that if there is an immediate or serious safeguarding concern, that person would go to the Garda, while if there is an ongoing, complex familial situation, that it go to the social work service in the HSE. What we are unable to do is have parallel reporting of information such that we could join the Garda and the HSE figures. They are different sets of figures, really, and how they are recorded and what they signify are different. That again leads to the point we are making that to get an overall picture of the level of abuse, if collecting in an overall sense was under the jurisdiction of the Safeguarding Authority, then we would get a picture of the level of abuse in the different categories overall. We would be able to monitor over time as to the changes and what areas legislation or enforcement should focus on. Trying to gather information in an overall sense would be where we would like things to be going.

Ms Patricia Rickard-Clarke

If I could just add to that in terms of the Garda, again the force wants very specific evidence to be able to prosecute, whereas in fact we should be sharing information at an earlier stage. I am involved with Sage Advocacy and we see a number of times where a person whose capacity is at issue, maybe their money has been stolen, their bills not paid or whatever, and the Garda says they lack capacity and do not even try to interview, even though the advocate may have very clear evidence of financial abuse. Again, we need the Garda to be very aware that it has an obligation to follow that even though it may not lead to a prosecution. If abuse at whatever level is taking place, it should be followed through on.

Deputy Emer Higgins

I thank the witnesses for being with us today and for their patience during that vote. I am sure it is not easy to have a meeting disrupted like that. I apologise that I am in my office. I am watching the Planning and Development Bill at the same time as I am a member of that committee. I am sorry not to be at this meeting in person. I think the witnesses' main message tonight has been that they need an adequate legislative framework with teeth when it comes to becoming a fully fledged authority in respect of oversight. That is where we as Oireachtas Members can help. The witnesses have listed three reports, from Bernard Gloster, the Minister of State, Deputy Butler, and the Law Reform Commission. The previous speaker asked a couple of questions on them. Only one of them is published at this point, with two more to come. My first question is asking for the witnesses to continue to engage with us on this. Once those two additional reports are published, we will probably have more information and more context in terms of the landscape we are operating in. It would be really good if the witnesses were in a position to come back in to the committee at that point to share their feedback on those reports once they are published and engage with us as to how we can build on the recommendations in them to make the legislative framework more adequate. My second question is about the 24-7 national call line they spoke about. Have they costed that and what are the budgetary ramifications of it? I am trying to keep it as quick as possible because I know it is late at night for the witnesses.

Ms Patricia Rickard-Clarke

Of course we will continue to engage and would be delighted to do so at whatever time and place. I cannot emphasise enough the importance of that legal framework and that it is not delayed. When we think back, it was 2017 when the initial adult safeguarding Bill was tabled. The Oireachtas Joint Committee on Health said it was an urgent matter to have safeguarding legislation in 2017 and 2018. We are here in 2024. In 2017, we also had the setting up of an advisory committee in the Department of Health on deprivation of liberty and here were are in 2024. There was a huge gap in that regard and it is now a very urgent matter. Absolutely we will engage.

On the 24-7 helpline, we do not provide any service at all. We have been asking the HSE. The HSE has a helpline between 9 a.m. and 5 p.m. and, I think, some limited services over the weekend, but it is not a national safeguarding helpline. Many people who are not interacting with health or social care would not have access. It is not a health matter. There is that massive gap and we need a national adult safeguarding helpline. There could be homeless people, say, or those who are subject to human trafficking or suffering large financial abuse, sexual abuse or whatever. If we get calls, which we do quite a bit, we try to signpost them to the Garda, the HSE or advocacy services insofar as we can, but there is that gap. There is not a proper service there.

Ms Annmarie O'Connor

Just to add, on behalf of Safeguarding Ireland I respond to some of the contacts that come in to us. I would highlight the importance of it being a dedicated support line for adult safeguarding. It is not just to take the call but also to initiate the response. As the Deputy is probably aware, An Garda Síochána might not always be the appropriate response. It is the one we would signpost people to when we think there is an immediate risk of abuse but it is not necessarily what is actually required. We certainly rely very heavily on signposting people to the advocacy services and back into the HSE adult safeguarding and protection teams. As Ms Rickard-Clarke has said, those services do not exist beyond the 9 a.m. to 5 p.m. hours. It is very important that something else is put in place.

Deputy Jennifer Murnane O'Connor

A lot of my questions have been touched on. When we read that 51,000 concerns about the abuse and neglect of adults have been reported to the safeguarding and protection social work teams since 2015, I am very uncomfortable that it is unknown how many of these relate to people with disabilities. The IASW has also established that An Garda Síochána cannot provide figures, as we have said, about the rates of abuse and neglect of residents. That is a massive concern. How do we work on this? I welcome legislation and feel we need to do it but I am firm believer in enforcement and common sense. That is something we spoke about earlier. Why is there under-reporting on safeguarding issues? What do the witnesses think could be the barriers to reporting? Communication was brought up as one issue. Are there particular issues with communication skills or whatever? How do we do it? It was said that if there are any issues, people should contact the Garda or go through the HSE. We know ourselves the Garda is crying out for more members. The HSE is under pressure too. I read here that HIQA has a role to examine the safeguarding measures in place to ensure they are as robust as possible. What does robust mean? From the time something is reported, timescale is of the essence. When we talk about "robust", I just think that needs to be looked at.

This is something that was touched on earlier. There is great work being done in the sporting organisations for safeguarding children. Everyone involved in a club has to take a course now so they know about safeguarding children and the reporting mechanisms. Why is that not the case for vulnerable adults? Why is that not happening? Safeguarding our adults, regardless of the situation, is everybody's business. We need to be mindful and listen to people's stories. The witnesses spoke about Covid. Do they think that Covid played a huge role in this? Everyone has the right to be safe and to live a life free from harm. We as policymakers and Government have to make sure everybody feels safe. They have to be free from harm. We need to work on some sort of a different system, and we spoke about common sense a few minutes ago and the issue of a call line out of hours. These are issues that need to be addressed. Money has to be put into areas where we need it most. That is not happening. We need to overcome it. There are significant issues within the system.

I thank the witnesses. I hope this is going to go some way to helping but I do not know, unless we have enforcement, proper regulation and things like that.

I have a concern in that regard.

Reference was made to education. I am a big believer in education and in people knowing that if they report something, it will not come back on them.

I again thank the witnesses. Like the Chair, I apologise that they had to wait such a long time to come back in.

Ms Patricia Rickard-Clarke

There is no national mechanism to collect figures on safeguarding. That is the big deficit. We need a framework and for all organisations to put policies in place, apart from the legislation. We need the legislative framework, but we also need all sectors and organisations to put in place policies to collect data. At the moment, if I can give an example, the Department of Social Protection paid out €25 billion in 2024 in pensions, disability payments and so on. The percentage of financial abuse is between 12% and 20%. It is much higher for people who are over 18 years of age. The Department has a vulnerable customers section. It will respond to complaints made, but it does not share that information with other organisations that need to know. It may stop paying a pension to the person who has been collecting it but not using it for the benefit of the adult who is entitled to it. We come across that quite often in advocacy organisations where other elements of abuse are happening. If the bank is notified, it can see that money is going out elsewhere and so forth. It is about all of that, the collection and sharing of data between organisations. There is no reason under the current legislation, either GDPR or the 2018 Act, why the information is not shared, but it is not done because there is no thinking around the necessity to do it. Everyone works in silos.

Why is it not reported? On the Emily case, people could not believe an elderly person was sexually abused in a nursing home. There is a lot of learning to be done in order that people understand and realise we need a legal framework. It will take a year or so to get the legislation. In the meantime, what can we do? I absolutely agree with the Deputy that we have to deal with this matter now. What we would look for, if the committee would agree, is the setting up of a working group to look at what the national safeguarding authority would look like. We will have the Law Reform Commission's report, which we hope will set out some of the teeth the authority should have, the composition of the authority, what Departments should be involved and which organisations should report. We cannot start looking at putting a system in place when the legislation is enacted. We must be ready to meet the legislation when it is enacted.

To return to the concerns about the HSE, there is huge under-reporting, but the question is what organisations have the responsibility under any policy to report this, that or the other. It may not be a crime or offence, but if a person is being abused or exploited, it should be dealt with.

An Cathaoirleach

I thank the members, Ms O'Connor and Ms Rickard-Clarke for their forbearance. I listened to the answers and to the questions posed by members today about the lack of clear governance by the State and the complexities of the matters. If the witnesses were handed a blank sheet of paper, what five key headings would they write down for the legislation that needs to be enacted? At the outset, they said there was a deficit in legislation, across all sectors. Their organisation is Safeguarding Ireland, which means safeguarding the community. How can we encompass every eventuality in legislation? Perhaps they should think about it before they respond. Perhaps we should look at it in more depth because there is a deficit in statutory regulation by the State.

There is also a deficit where the State has regulatory bodies with powers, such as HIQA, and services need to be provided but resources do not follow the reports. There is a serious challenge. We see it in the unmet need in the community, particularly in respite, in the regulatory framework that is in place and that the resources have not followed the regulatory framework. Any new regulation we put in place has to put a burden on the State to provide the proper resources to ensure we are providing for our most vulnerable citizens.

Mr. Ronan Cavanagh

I will say something and then hand over to Ms Rickard-Clarke. On the timeline, we understand it will be soon - a matter of weeks rather than months, but certainly soon - that the Law Reform Commission regulatory framework recommendation report will come out. We understand that a big part of it will be about recommendations on the legal set-up of a national safeguarding authority. Our view is that, in a comprehensive sense, when you talk about the five key ingredients, the authority would be broadly encompassing and would deal with those issues in an overall sense. What we would like to come away with today is a sense that when we have clarity on that, that we could come back to the committee for any assistance with what the key points are and what a working group that has been established could be working on. What we do not want is the report to come out and then for there to be a long process. Are there things on which we could provide clarity to the committee in terms of a working group? Is there a process we could help to distil. The five key points would sit within the national authority which would take ownership of the cross-sectoral complexity of it. The aim is that the authority would be a key vehicle for dealing with that.

Ms Patricia Rickard-Clarke

I will add one point we have not mentioned, which is critical, especially for people who are at risk. It is the need for statutory recognition of independent advocacy and independent advocates. Certainly, now that the Assisted Decision-Making (Capacity) Act has commenced, the role of the independent advocate has become critical in ensuring the voice of the person is heard, apart from conflicts with families or services or whatever. As part of that legislation, if it is not already in place before that - I hope it will be in deprivation of liberty legislation - a recognition of the statutory requirement for adult independent advocacy will come. It is an important issue. Advocacy should be independent of service and independent of family. The voice of the person must be clearly assisted and supported by that advocacy service.

An Cathaoirleach

I thank the witnesses. It is thought-provoking and challenging but it needs to be done.

I thank members for the dual meeting, or whatever it was. I thank everyone for sticking with us. I thank our team, who do an excellent job and are working flat out behind the scenes to keep everything going. I thank everyone sincerely.

The joint committee adjourned at 7.49 p.m. until 5 p.m. on Wednesday, 28 February 2024.