JOINT COMMITTEE ON HEALTH AND CHILDREN díospóireacht -
Tuesday, 25 Jan 2011

Human Rights Issues: Discussion with Irish Human Rights Commission

Chairman

From the Irish Human Rights Commission I welcome Dr. Maurice Manning, president, who is no stranger to these Houses, Mr. Des Hogan, deputy chief executive, Professor William Binchy, member, and Ms Sinead Lucey, senior inquiry and legal officer, to the meeting. I apologise for being late in getting to the delegation. We were sharing some valedictory statements given that this is the last meeting of the committee.

By virtue of section 17(2)(l ) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. If witnesses are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable.

The documentation has been circulated to all members. Perhaps we can be given a synopsis of it, after which I will take questions from members and return to the delegation for a wrap-up. I invite Dr. Manning to lead off.

Dr. Maurice Manning

We are very pleased to be here. We also appreciate the fact that this committee is going ahead today given the circumstances in which we are operating. I thank the committee for that. We will try to be as brief as we possibly can.

This is the third inquiry undertaken by the commission, Ireland's national human rights institution, in accordance with our statutory functions under the 2000 Act, to conduct an inquiry into any human rights matter. To set out the background, the initial request to conduct an inquiry came from a group comprising the parents and siblings of adult persons with a severe to profound intellectual ability residing in the John Paul Centre in Galway city run by the Brothers of Charity. The concerns of the group related to under-funding, overcrowding, inadequate staffing and a lack of therapies and activities, most specifically speech and language therapy. The group contended that these issues were having a profoundly adverse impact on their family members residing in the centre. From the perspective of the commission it appeared that the question to be addressed was whether the relevant law in practice in the State sufficiently vindicated the human rights of those living in the centre. On that basis the commission decided to conduct the inquiry.

The report is an important publication in regard to the provision of services to persons with intellectual disabilities because for the very first time a statutory inquiry has examined the range of human rights which are owed to this particularly vulnerable group. Commission inquiries are not adjudicatory exercises but must be linked to the performance of a number of the commission's other functions, such as keeping under review the adequacy and effectiveness of law and practice in the State relating to the protection of human rights and making recommendations to the Government on the measures which should be taken to strengthen, protect and uphold human rights. As such, we do not determine whether human rights violations have occurred in individual cases but we focus on structural or systemic issues. Our recommendations are important because they look at the issues which underpin the protection of human rights or lead to a breach of these rights. These recommendations are appended to this presentation.

Before passing on to my colleagues I wish to record the excellent co-operation afforded to the commission by all parties throughout the inquiry and the welcoming nature of the engagement by the Brothers of Charity which runs the centre in Galway, some of whose leading people are present. We hope the excellent co-operation enjoyed during the inquiry will be matched in the implementation of our recommendations particularly our structural recommendations addressed to the State parties. I ask Mr. Des Hogan to address the mechanics of the inquiry.

Mr. Des Hogan

This inquiry took place from 2008 to 2010. It was conducted through research, correspondence, examination of documentation, reports, responses, interviews and meetings with the relevant stakeholders. In our briefing paper we set out the parties to the inquiry, the parent group who requested the inquiry, the Brothers of Charity Services Ireland in Galway, the Health Service Executive, the Department of Health and Children, the Department of Education and Science and the Health Information and Quality Authority.

Under the commission's powers, we require the production of detailed documentation and information, which was duly provided. We met the parent group, who requested the inquiry, and the Brothers of Charity. We visited the centre on several occasions and had the opportunity of viewing the facilities. We met the parents, management and staff, care professionals and some of the individuals in the centre, and we observed the genuine warmth and care for the individuals demonstrated by staff at the centre. From the beginning the parent group has praised the care staff at the centre, referring to them as heroes.

The current inquiry related to one residential day and respite care facility but, in accordance with its inquiry power, the commission looked at the bigger picture throughout. Whereas the centre in Galway provides services to 77 individuals, currently 26,000 individuals in the State are registered as having an intellectual disability, 5,000 of whom, almost 20%, have a severe to profound intellectual disability.

The position in the centre is a consequence of the strategies, legislation and policy framework set at the national level and which directly impacts on these vulnerable individuals. Thus, in the inquiry, the situation in the centre was considered against those national frameworks. The inquiry then considered the international human rights standards which are applicable before analysing the factual position on the ground against those standards. This allowed the commission to draw its conclusions and make recommendations on the measures that need to be taken.

Professor William Binchy

I will speak briefly about the human rights standards on which the report is based and then look at the response. Given that the committee has an indication of my remarks, I will curtail them a little.

Human rights standards which underline this type of inquiry range widely. They include the right to health and education but also the right to equality and non-discrimination, the right to an effective remedy and, at a more profound level, the right of every human being to be treated with dignity, humanity and respect. As has been indicated, we made a wide-ranging series of recommendations for the individual stakeholders. In terms of a summary outcome, this involves a reframing of how disability services are planned and delivered to respect human rights, involving Ireland in the ratification without delay of the UN Convention on the Rights of Persons with Disabilities and the need for independence, inspection and monitoring of all residential centres in the State.

At a structural level, the crucial point is that the individual should be seen as the beginning point, the centre of service provision. One should begin with the individual and work out the implications socially - the individual needs and the individual rights - rather than beginning at the top in terms of a macro approach and hoping sufficient money will be channelled downwards to allow for the individual needs. This type of individual centredness is at the heart of the Disability Act 2005, which has not been fully implemented, and the Health Act 2007.

We are conscious of the economic difficulties Ireland faces at present. No one can wave a magic wand in this area but there is a human rights dimension to how a State deals with an economic crisis. There are well-established principles of human rights law that apply at international law level. These involve, essentially and importantly, the principle of non-discrimination which is crucial in dealing with questions affecting disability. We have had some responses but the greatest concern from the commission's point of view is that despite several requests we have not yet received any substantive response from either the Department of Health and Children or the Department of Education and Skills. We have received responses from all the other stakeholders. The Brothers of Charity has undertaken to draw up a detailed action plan on the implementation of the recommendations in the report and has distributed the report to parents and staff and engaged in consultation. It has responded more widely than that but that is a short summary.

The Department of Education and Skills has indicated that it is intended to withdraw the already limited funding for educational services provided to the centre, as disclosed by the Brothers of Charity. Since the report was published less than a year ago, two community homes have closed and there are three vacancies in residential services which have not been filled from the waiting list. There are more concerns in that area.

In the area of multi-disciplinary services the Brothers of Charity is dependent on funding from the Health Service Executive. It appears that far from implementing the recommended increases in such services it is proposed to cut same. The psychiatrist who is employed directly as part of the multi-disciplinary team at the centre retired in 2010. In the meantime it has had a locum in place but no agreement from the HSE in regard to recruiting for that position. I am concerned that the psychiatry services may only be provided on a clinic basis in the future, diminishing further the multi-disciplinary service within the centre. The HSE has responded by stating it is working on a value for money and policy review to be completed this year and is expecting a report that will clarify what constitutes health and personal social services. Linked to this review, the HSE is also engaged in a costing exercise and should then be able to establish average costs for residential respite and day services. No timeline has been indicated as to when this will be completed. It is in discussion with the Department of Health and Children on the development of information and data gathering and has also engaged with HIQA on national quality standards about which I will speak in a moment.

Although the HSE does not specifically refer to funding cuts to the Brothers of Charity, it states that no additional funding was allocated to appoint new therapists to the centre in 2010. A sum of €217,500 new funding was allocated specifically to the centre. A sum of €70,000 was used to move five individuals from the campus to community-based housing and the remainder was allocated for residential services for ten adults. The commission understands that this was used to enhance existing respite services. The HSE has also agreed with the Brothers of Charity that there will be no cut in the level of respite care in 2010. A number of recommendations in the report to the HSE were left unaddressed in the response it gave to us.

HIQA has informed the commission that parts of the Health Act 2007, conferring registration and inspection functions in regard to residential facilities for persons with disabilities on the chief inspector of social services, had not been commenced and that this remains the case to date. We sought further information from HIQA in this regard and on the implementation in practice of the national quality standards.

The parent group is extremely concerned at even being able to keep the minimum of services available in the centre and is engaging with the Brothers of Charity in progressing the recommendations in the report directed at enhancing relationships at local level.

It is the firm view of the commission that the people at the heart of this inquiry must receive the support necessary to protect their dignity and worth. There is a minimum level of rights under which no person should be forced to exist, least of all those who cannot speak for themselves.

Chairman

Does Ms Lucey wish to add anything?

Ms Sinead Lucey

No.

Deputy James Reilly

I must leave but I thank the delegation for appearing before the committee. I have listened to what it had to say but Deputy Charlie O'Connor will respond on my behalf. Sorry, Chairman, Deputy Charles Flanagan-----

Chairman

I do not know how the Deputy could possibly confuse Deputy Flanagan with Deputy O'Connor.

Deputy James Reilly

My apologies.

Deputy Charles Flanagan

I also welcome the representatives of the Irish Human Rights Commission to our meeting. What we have heard is indicative of the type of dysfunction in the health services which is most regrettable. It is not surprising given the content of the report that the parent group and everybody involved are not only frustrated but extremely concerned. I would hope this committee might be in a position to advance matters for those involved being, perhaps, the most vulnerable groups in society.

I note the opening statement by Dr. Manning in which he outlines the role and functions of the commission, and said that commission inquiries are not adjudicatory exercises but rather commentaries. In my view that is a weakness because I am not sure what role and functions a committee, such as an Oireachtas committee, might have other than highlighting an issue which, as active and positive public representatives, we should be aware of in the first instance. I wonder what the response of Government has been on the basis that the inquiry has been put in the form of recommendations to the Government, in particular the Department of Health and Children. I am not sure of the timelines involved. Perhaps Professor Binchy is in a position to advise as to the date on which the report was concluded and the date it was forwarded to the Department of Health and Children in the form of recommendations. What was the nature of the deliberations, if any, with officials from the Department of Health and Children since the date of completion of the report?

It appears that funding is the main issue. Has any subsequent report been agreed between the managers of the centre, the HSE and the Department of Health and Children as to what would be the minimum cost to ensure that the law is fully complied with?

Chairman

May I interrupt the Deputy. A vote has been called in the House. I suggest we suspend until the vote is over and resume immediately thereafter.

Sitting suspended at 3.10 p.m. and resumed at 3.30 p.m.

Chairman

I apologise to the delegates for the interruption.

Deputy Charles Flanagan

I welcome the opportunity to discuss this important report which is helpful in highlighting the unsatisfactory state of affairs in the institution concerned. The issue seems primarily to be one of funding. On the basis of ensuring a level of funding which, if not ideal, could at least be regarded as tolerable, does the commission envisage any further function for itself in monitoring the situation? In other words, is there a role for the commission beyond making recommendations by way of consequential monitoring?

Apart from the question of funding, what might the Legislature do - from a legal perspective, for example - to ensure a basic level of service? In his submission Professor Binchy mentions contact with the Department of Education and Skills. I am not sure anyone referred to the response from the Department of Justice and Law Reform regarding the ratification of the UN Convention on the Rights of Persons with Disabilities, but I see that as an important step forward.

I am open to correction on this point, but it would appear that the management of the institution, the Brothers of Charity, prepared a report that could be described as laudable. Unfortunately, it seems that report was not accompanied by the same effort or commitment on the part of the authorities, namely, the Health Service Executive and - to a greater or lesser extent, depending on how one looks at it - the Department of Health and Children.

It is important that the committee considers the report, although I am not sure of the extent to which we have any power to ensure remedies other than by way of making a strong all-party recommendation that the Department of Health and Children and the Health Service Executive deal with this matter as one of extreme urgency. It is less than satisfactory that the Health Act 2007 is still not functioning in its entirety, thus precluding the Health Information and Quality Authority, HIQA, from the responsibility we bestowed upon it in that legislation. If we are to make a recommendation to Government, it should emphasise the importance of ensuring that all sections of the Act are subject to commencement to allow HIQA to engage in the type of activity that might give rise to a resolution of this issue.

Deputy Kathleen Lynch

I welcome the delegates. Any investigation by the Human Rights Commission of a particular issue serves to shine a spotlight on it and is always to be welcomed. It is vital that some of the recommendations in this report are implemented. It is stated at the beginning of the delegates' submission that its investigation was prompted when it was contacted by a parents' group. Most people who have an adult child in need of special care, as opposed to a child with special needs, are reluctant to approach an outside agency in regard to concerns in respect of their child's care giver because there are so few centres in this country providing the type of care required. There must have been concern at a very deep level for the parents to approach an agency such as the Human Rights Commission.

That said, the main issue in regard to those who care for people with intellectual disabilities, especially where there is an active parents' group, where the persons being cared for have family support and where those families interact with the residential centre, is usually about communication and about ensuring there is compliance with the legislation. A significant difficulty in this area, as the commission points out in its report, is that the Disability Act is not rights-based and matters are therefore very much at the behest of the funding organisation.

Another difficulty for the commission is that the national standards are not applied to homes. I am always reluctant to call them "institutions" because we must be conscious that they are home to those who live there and that none of us would like our home, no matter how dysfunctional, referred to as such. Many care givers are worried about implementing the standards. However, those standards relate very much to the rights and privileges anybody would expect in his or her everyday life, including choices about what television programmes to watch, what to do with one's day and what types of foods one can eat. It is not about stipulations that every socket be 12 ft. off the ground and every television set have an automatic shut-off button. That is not what the standards are about. Clearly there are requirements in regard to the application of care, but the aspects which impact most significantly on people's lives are the mundane issues which concern all of us in our daily lives.

A significant drawback under the current regime is that the legislative provisions relating to HIQA have not been implemented. Even when HIQA representatives are allowed to enter and inspect homes, there is no statutory function in that respect. If the commission's recommendations in this regard were put in place we would see an entirely different attitude towards those people who rely on us for their everyday needs. It ultimately comes down to a question of respect. If we were all to consider the care provisions of those who need care in light of the standard of care we would want for ourselves in similar circumstances then we would have come a long way. It does not always have to be about high finance or high technology. There are people who need intensive care but, in most cases, it is about respect, warmth and compassion. An outside agency has a vital role to play in ensuring that is done. There will always be difficult circumstances and an external person may be better placed to offer alternatives and solutions.

I am pleased to note that the parents in this case are in ongoing contact with the Brothers of Charity. At the end of the day everybody involved - care givers, the persons receiving care, their family and friends and the people working within the organisation - has one aim, namely, that people receive proper care, that their lives have meaning and significance and that they are supported in living long and healthy lives. The report is not overbearing in this case. Sometimes people have the impression that the Human Rights Commission is talking about angels on the head of a pin. That is not the case. This is about how we would all like to be treated. I thank the delegation for the presentation.

Deputy Jan O’Sullivan

I will be brief. I welcome the delegation from the Irish Human Rights Commission, in particular Dr. Manning, a former colleague in Seanad Éireann. I thank the delegation for its report and presentation.

The dilemma is implementation of people's human rights versus funding, which has always been a dilemma. I was Labour Party spokesperson on education during the passage of the Education for Persons with Special Educational Needs Bill 2004. A similar problem arose in terms of the Disability Act in that provision in that legislation was based on the availability of resources.

How difficult is it to implement rights legislation and human rights in general when operating in the context of diminishing resources, which is at the heart of the difficulties highlighted in this report? I welcome that the Brothers of Charity have developed an action plan. They have clearly set out their difficulties in terms of implementing the report's recommendations as a result of cuts in funding from the Departments of Education and Science and the Health Service Executive. The dilemma at the end of the day is how to achieve what one wants to achieve.

One of the recommendations which I found interesting is that on page 15, namely, that the HSE should work closely with the Department of Health and Children in driving a working group comprising Department officials, HSE and service providers to establish an agreed national average cost for residential respite and day services and so on. While the Irish Human Rights Commission report is focused on a particular centre similar difficulties are being experienced in various parts of the country. At the time the issue around respite in Galway arose we were experiencing difficulties in Limerick in respect of respite for a similar group of service users. The families were asked to fund raise, to accept more costs and fewer hours in terms of respite for their adult dependants and ultimately had to accept that because the alternative was that they would have no respite, which they needed. In one case an elderly woman who needed to go into hospital had no one to look after her adult son. In the circumstances, the families had to take on some of the costs and to fund raise privately to do so. It is a real dilemma.

I understand that the families identified in the report are experiencing difficulties in a particular place. I wish them well and hope that as a result of this report they will get a better service. To what extent do the recommendations in the report have general application in respect of families in similar circumstances? All of us as public representatives, and those of us who may well end up in Government parties following the election, will have to face the challenge of limited resources and trying to implement people's rights in that context. Any wisdom the delegation may have to impart in terms of the priorities of people in decision making roles would be welcome.

Deputy Charlie O’Connor

I, too, extend a warm welcome to Dr. Maurice Manning. I was going to call Dr. Manning President Manning but that might be misunderstood. I am delighted to welcome the delegation to the meeting. I get a sense that this may be my last opportunity to address the Oireachtas Joint Committee on Health and Children. I wish well those colleagues who expect to be in Government. I would like to believe I am in the presence of the next Minister for Health and Children. However, the decision in that regard will be the prerogative of others.

Deputy Kathleen Lynch

I do not think Deputy Flanagan wants the job.

Deputy Charlie O’Connor

I wish my colleagues well. It is important we have these sessions. It is unfortunate that the Irish Human Rights Commission comes before us at a time when the Parliament is into its last few days. Nevertheless, it is important we take note of what the delegation has to say.

With my colleagues, Deputy Ó Fearghaíl and others I was a member of the former Eastern Health Board in 1994. I was also a member of the former regional authority. One of my most profound experiences was our visits to institutions in which people are catered for given the difficulties in that regard as outlined in the report. I often said, with all that emerged during that period and since, that I hoped that what was going on behind closed doors now would not be spoken about in a negative way in 40 years' time. I would hate to think, in the times in which we are now living and operating, that these types of things are continuing to happen. For that reason, it is important we support the efforts of the Irish Human Rights Commission in this matter. It is unfortunate that this is the last opportunity we will have to do so. I hope this report will be carried forward and acted upon and I recommend doing that to the joint committee.

I wish the Irish Human Rights Commission well. I also wish the Chairman and staff of the joint committee well in the context of this possibly being the last meeting of this committee.

Chairman

It strikes me on reading the report that one of the pressing issues is a response from the Departments of Health and Children, Education and Skills and the Health Service Executive. In the short time remaining to it, the joint committee will be unanimous in its approach to those Departments to respond speedily to the issues raised with us. The Irish Human Rights Commission should not have to attend before the joint committee to seek those responses. They should be readily forthcoming having regard to the importance of the issues raised. I commend the commission on its work.

It is stated at page 4 of the report that the John Paul Centre was examined in the context of the bigger picture. Perhaps the delegation will outline how it found that centre, how it relates to the experience across the country, whether it found variations in terms of quality and extent of services available to people and how the issues important to it, going beyond the resource issue, are being addressed.

Dr. Maurice Manning

On behalf of the Irish Human Rights Commission, I thank all members who contributed for their positive and supportive reaction to the report. I am conscious that this may be the joint committee's last meeting. We appreciate the joint committee making time available to meet us. Despite the fact that this may be the last week of the current Government, these issues will not go away. They will at least have been well ventilated today and the report will be available to members' successors on the joint committee, whoever they may be.

I will ask Mr. Hogan to address some of the specific issues, following which Professor Binchy will address any outstanding issues.

Mr. Des Hogan

I will commence by responding to the Chairman's questions and will then try to address the bigger picture question. When conducting this inquiry we looked at one centre and as such many of the micro recommendations are relevant to it. However, in terms of the bigger picture, in so far as the same issues traverse other centres, residential, day and respite, the same recommendations apply. We visited and observed conditions at the centre on a few occasions. We found the front line care staff tremendous and the parents have nothing but praise for them. The management in Brothers of Charity were welcoming and made every facility available to us at all times. They were also the first to respond to any questions we had or to provide any documentation we requested.

Essentially, we dealt with individuals with a range of severe to profound intellectual disabilities traversing psychiatric, psychological, social and mobile impairment. Unfortunately, we are discussing an individual who needs speech and language therapy in order to eat without choking. These citizens cannot speak. They rely on others, such as their parents, families, care workers and advocates, to speak for them. We are not saying that speech and language therapy would be nice; we are arguing that it is essential. Similarly, Professor Binchy noted the deficit in psychiatric services in the Brothers of Charity. We made a recommendation that services be augmented rather than reduced.

In terms of the bigger picture, we found serious deficits in the way disability services are being delivered. They are top-down rather than bottom-up. Deputy Charles Flanagan asked a question regarding when we wrote to the parties concerned. We sent the draft report to interested parties in November 2009 and received responses over the December to January period before publishing the report in March. Respondents outlined the actions they intended to take. The HSE and the Department of Health and Children described the improvements and new models that were in train. When the report issued, we indicated that we would seek updated recommendations in September. When we wrote to the interested parties in September, we received a prompt response from the Brothers of Charity and a slightly later response from the HSE. From September through December and again this month, the Department of Health and Children promised that it would deliver a response. Unfortunately we have not received a substantive response from the Department of Education and Skills. There have been developments but the process is very slow.

One of our recommendations was that the national intellectual disability database should be reformed in order to re-adjust service delivery. At present, it is self-reporting against various modules but it needs to be accurate if it is to properly assess what people need from different centres. The service level agreements between the HSE and the charities running the services also need to be restructured to allow for increased accountability and control because there is a lack of State supervision at present.

We tried to give feedback on the basis of promised or mooted reforms on the part of the HSE in terms of the reviews it was going to undertake. Members or their successors may wish to take on board two specific recommendations in regard to reporting to this committee on risk prevention where issues of abuse potentially arise and on the HSE reviews which were supposed to replace HIQA in this area. We believe HIQA inspections should commence without delay. Given all the reports that have issued on abuse in other contexts, the absence of an independent inspection mechanism is worrying.

In regard to Deputy Kathleen Lynch's question on standards, although HIQA standards are not being applied nationally, some charities, including the Brothers of Charity, have received accreditation through, for example, the Council on Quality and Leadership, which sets out standards that are similar to those of HIQA. However, charities should not be required to take this action because these are citizens and the State ought to be responsible for them.

A number of steps need to be taken to turn the situation around. We are not suggesting there is no upper ceiling on resources but once we find out individuals' needs from the bottom up we can have an accessible and transparent discussion about available resources. International human rights standards for health allow for that sort of rationing of health services. Everybody can have faith in the system if we are able to have a civilised and informed discussion about how we are going to provide services on the basis of non-discrimination.

The health legislation needs to be implemented and the disability legislation only applies to those aged under five. The Education for Persons with Special Educational Needs Act 2004 needs to be brought into force.

Deputy Kathleen Lynch

As does the mental capacity Bill.

Mr. Des Hogan

In terms of ratification of the Convention on the Rights of Persons with Disabilities, absolutely. The Mental Health Act 2001 will probably also require amendment in order to ratify the convention. If one thinks about the purpose of the Education for Persons with Special Educational Needs Act, these individuals were failed while they were young and if this is to be prevented from happening again, they cannot be left behind. If the State approaches intellectual disability services in the right way, the level of individual care needed and the costs involved will fall because if an individual is mobile and capable of a certain degree of self-determination, the current type of intensive problems will no longer arise.

When there are insufficient staff to cater for persons with serious to profound intellectual disabilities, challenging behaviour will result. In this case, two individuals require 24-hour wrap-around behaviour therapy, the huge cost of which has to come out of the funding pool. As charities have legal obligations in terms of capital and staff, reductions in State funding come out of the non-pay elements and services get hit first. The Brothers of Charity appears to be dealing with one emergency after another. Under its agreement with the HSE it is required to deal with all persons in its catchment area. It is a question not just of the people in the centres but also those who are on waiting lists for respite, day or residential care. These different problems are accumulating.

We received excellent co-operation in producing our report but we were trying to identify the next steps which could be taken quickly. It is disappointing that has not yet happened but we will continue to work in this area. It is welcome that we are able to raise some of these issues with the committee.

Professor William Binchy

I will be brief. Mr. Hogan addressed a number of questions which members raised. Deputy Charles Flanagan raised an interesting point about adjudication versus non-adjudication. The commission can do either but the adjudication route is expensive and requires that due process and the constitutional rights of those involved are respected. An inquiry thus becomes a matter of contestation. Undoubtedly that type of inquiry will be needed in certain cases but the inquiry we are discussing lent itself to a non-adjudicatory, albeit fact finding, route whereby stakeholders were involved in a participatory rather than adversarial fashion. The truth emerged such that there was no contest about the facts of the situation. We believe that is the appropriate way to deal with a report that covers both State policy and focused issues in respect of the Brothers of Charity centre in question.

The Deputy also asked the interesting question about whether this is the end of the line as far as we are concerned. That is definitely not the case. We are prepared to appear before the committee again because we have an ongoing responsibility to keep human rights under review and a failure to respond to our inquiries would raise issues of neglect of human rights. Furthermore, we can make our voice heard in regard to Ireland's international responsibilities under several international covenants and conventions, such as the International Covenant on Economic, Social and Cultural Rights or the universal periodic review. We will set out the response, or lack thereof, of the State in these areas.

Deputy O'Sullivan made an important point about the economic implications. As Mr. Hogan noted, nobody can wave a magic wand to remove cost implications in times of great economic difficulty. Interestingly, however, the human rights centred approach offers hidden benefits. Mr. Hogan mentioned benefits in terms of how limits to care create extra responsibilities for those who run the centre. The same would apply in the context of speech and language therapy, which deals with the fundamental functions of swallowing and digesting food. If these matters are not addressed comprehensively at an early stage, they can have significant medical consequences. Adopting a proactive individual centred approach can provide economic savings rather than necessarily involve further expenditure.

Deputy Kathleen Lynch raised that point about "respect" being the key word, and I agree entirely. I think we all agree. It is fair to say that the United Nations disability convention of 2006 is really a respect convention in the sense that, as the Deputy will be aware, it takes an entirely different approach from a social welfare or medical model, and treats the human rights of every human being, including persons with disabilities, as worthy of equal respect. That involves a gradual cultural shift, but if that cultural shift is made and if respect is given to every human being, including persons with disabilities, then they would be seen not as an exceptional charge on the Exchequer but rather as having entitlements which must be fulfilled by the State.

Chairman

Are there any concluding remarks?

Ms Sinead Lucey

This is not so much a concluding remark but an important practical point, picking up on what Mr. Hogan stated about reforming the national disability database. There is already a mechanism, under the Disability Act 2005, by which we can get an accurate picture of the needs of persons with disabilities. That is separate from the resources needed to meet those needs but we would have a clear database if that was rolled out at that level.

I also want to touch on something Professor Binchy mentioned, that is, the cost of not delivering services. I am not sure if anybody has ever looked at that side of the coin, but not meeting their needs definitely leads to a considerable cost to the mental and physical health of people such as the individuals in this centre. On the amount one can put into multidisciplinary services, the benefit of just having one extra speech and language therapist is phenomenal. That small resource can have a significant benefit.

I also mention briefly in this context a cohort which was not really the subject of our report but which is probably worthy of mention here, that is, those persons with intellectual disabilities who are still residing in psychiatric institutions. That is truly tragic.

Dr. Maurice Manning

I thank the Chairman and the committee for the courteous way in which it received us and for the hearing it has given us. I hope that the report, and the way in which it has being dealt with here this afternoon, will contribute in some small way to a more urgent addressing of the problems it raises. At a personal level, I wish all of the four Members who are still here the very best of luck over the coming six weeks. I hope they all are successful.

Chairman

I thank Dr. Manning and his colleagues.

Is it agreed that we write as a matter of urgency to the Department of Health and Children and the HSE and the Department and Education and Skills expressing the unanimous view of the committee that the issues raised by the Irish Human Rights Commission be addressed? Agreed. Is it also agreed that we suggest that this matter should remain on the agenda for consideration by the incoming committee? Agreed.

The joint committee adjourned at 4.05 p.m. sine die.