This morning, we engage with the Health Information and Quality Authority to discuss its 2023 financial statements. From the authority, I welcome Ms Fitzgerald, Mr. Finbarr Colfer, chief inspector designate, Mr. Sean Angland, chief operating officer, Mr. Sean Egan, director of healthcare regulation and Ms Susan Cliffe, deputy chief inspector with responsibility for older persons services. From the Department of Health, I welcome Mr. Patrick Dolan, principal officer in patient safety policy and governance and Mr. Niall Sinnott, principal officer in ehealth and health information systems. From the Health Service Executive, I welcome Ms Patricia Whelehan, assistant national director of services for older people - access and integration, Ms Amanda Casey, chief social worker, and Mr. Pat Healy, national director of national services and schemes. We are joined by officials from the Office of the Comptroller and Auditor General, including the Comptroller and Auditor General, Mr. Seamus McCarthy, who is a permanent witness to the committee, and Mr. Mark Brady, deputy director of audit. You are all very welcome.

I will explain some limitations to parliamentary privilege and the practice of the Houses as regards reference witnesses may make to other persons in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to the Constitution and statute by absolute privilege. This means they have an absolute defence against any defamation action for anything they say at the meeting. However, they are expected not to abuse this privilege and it is my duty as Leas-Chathaoirleach to ensure this privilege is not abused. Therefore, if their statements are potentially defamatory with regard to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction. Witnesses are also reminded of the long-standing parliamentary practice that 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 or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory regarding an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.

I ask Mr. Seamus McCarthy, the Comptroller and Auditor General, to make his opening remarks.

Gabhaim buíochas leis an Leas-Chathaoirleach. The Health Information and Quality Authority was established in 2007. Its primary functions are to set standards and regulate health and social care services, and to advise on the collection and sharing of information across healthcare services. Much of the authority’s work is focused on inspections across the disability, older people’s and children’s sectors. Designated residential care centres must formally register with the authority.

The authority’s financial statements, like some others in the broader health sector, are presented with separate income and expenditure accounts, covering current and capital spending. The income and expenditure account on the current side records total income in 2023 of €38.5 million. Of this, €7.4 million, or around 19%, was received from registration and annual fees paid by regulated residential centres. Most of the remaining income in 2023 was received from the Vote for health. Some €1.1 million was received form the Vote for children, equality, disability, integration and youth. The latter was provided in respect of the authority’s role in monitoring the International Protection Accommodation Services' residential facilities.

The authority’s recurrent expenditure in 2023 was €38.3 million, of which 75% related to staff costs. In 2023, the authority’s average headcount was 351, with 80% of those staff employed in regulation functions. The authority recognised capital funding of €5.8 million in 2023, including €4.78 million from the Vote for health, as reflected in the capital income and expenditure account. Total capital expenditure was also €5.8 million, €2.3 million of which was spent on what is referred to as "software in the cloud". This expenditure relates mainly to the costs of a major ongoing ICT project for the development of new regulatory software systems for the authority, to be hosted by an external service provider under a multi-year service contract. The ICT software development costs are a charge on the authority’s capital income and expenditure account, but under accounting standards, they do not result in the creation of a related intangible asset on the authority’s statement of financial position.

I issued a qualified audit opinion in respect of the authority’s financial statements for 2023. The qualification is only in relation to the authority’s accounting treatment for pensions. As provided for by law, the Minister for Health has elected to direct certain health sector bodies, including the authority, to account for staff pensions as they are paid. Generally accepted accounting practice requires recognition of pension liabilities as they accrue.

Other than that, I am satisfied that the financial statements give a true and fair view of the authority’s financial position at the year's end and of the transactions for the year.

I thank Mr. McCarthy. We move to our other witnesses. As the officials can imagine, there was significant concern from members about what was portrayed in the "RTÉ Investigates" programme and they intend to ask questions about that. We hope the officials will be able to provide reassurance but also deal with other questions that have been raised by the Comptroller and Auditor General.

We will now hear the opening statements of our other witnesses. I ask Ms Fitzgerald to make the opening statement for HIQA.

I thank the Leas-Chathaoirleach. I wish everyone a good morning. I thank the committee for inviting us to discuss HIQA's financial statements. We will of course be happy to address the questions the Leas-Chathaoirleach raised.

As was already said, HIQA was established in 2007 as the independent regulatory authority. Our role is to enable the best possible outcomes for people using health and social services. Our legal remit includes setting standards, regulating public, voluntary and private health and social services and providing evidence to inform and support Government policy decisions. Protecting the safety and welfare of people using health and social care services is at the heart of what we do. Regulation seeks to provide independent oversight of the quality and safety of care and support and aims to drive continuous improvement. To put our role into context, the chief inspector regulates over 2,000 nursing homes and disability services. He also has a role in relation to specific aspects of children's services. In healthcare, we monitor the quality and safety of public and private healthcare services. We also have a role in relation to permanent IPAS centres.

It has to be said the primary responsibility for day-to-day quality and safety must rest with the service provider. Our role as the regulator is to ensure providers have systems and processes that are effective to assure themselves in the first instance that people using their services are getting the support they need and deserve. This is why governance and management are central parts of our inspections. This seeks to allow us to help providers move beyond simple regulatory compliance towards continuous improvement.

What have we done and how have we had an impact? It is fair to say that, in the lifetime of HIQA, we have driven a move from a medical to a social model of care in the area of social care and, in particular, a focus on a person-centred and human rights-based approach.

Often, the improvements achieved for people are things that we in society take for granted. For example, they mean that people living in nursing homes can exercise choice and autonomy in their daily lives and can enjoy privacy and dignity. In the context of disability, we have seen a significant move out of congregated settings into community. People tell us every day about the impact this has had on their lives. In children’s services, we have driven improved oversight and improved delivery of safety for those children who are most at risk. We also know that, as the regulator, we have much more to do. As the regulatory landscape changes, we have to adapt and change.

Other areas we are involved include setting national standards. National standards in regulation set the bar for driving continuous improvement. We also provide advice to the Minister and the HSE on the clinical effectiveness and cost-effectiveness of health policies and in respect of vaccination and screening programmes. One example was that during Covid, our team played a pivotal role in providing the evidence to support Government in making rapid decisions on public health issues. We work collaboratively with the Department of Health on informing national health information policy and digital health policies. We are currently developing an ethical framework for AI, which is rapidly coming into health and social care.

Listening and responding to people, taking the Leas-Chathaoirleach’s point, has to be part of what we do every day. We listen to residents, patients, families and inspectors but we also try to use our voice to advocate for policy or regulatory change, and we can talk about that today. One other area that may not necessarily be associated with HIQA is the national care experience programme. This is a unique national collaboration between HIQA, the HSE, the Department of Health and patient advocacy groups. The findings give us clear insights as to what matters to patients and their families and allow us to help service providers drive those improvements. We also work with the Department to try to look at structural or other issues that might improve the experience of residents.

Our organisation is 18 years old. Our chair often describes us as a teenager organisation. Our remit has grown significantly under successive Governments. In the past two years alone, as evidence of that rapid expansion, we are now moving into monitoring private hospitals. We have a role in relation to international protection, we were asked by Government to review the mid-west in terms of urgent and emergency services. We have contributed significantly to the work of the Department and the Law Reform Commission in the area of adult safeguarding. We drafted standards for home support services that will be the bedrock of the regulatory framework that is coming. We recently assumed responsibility for the national immunisation advisory committee. As mentioned earlier, we published a review on the use of non-CE springs in children. We have also been asked to take on a role with regard to critical entities resilience, which is how we protect the State against external shocks.

On the matter at hand today, namely financial resources, the C and AG has already mentioned some of the areas involved. As a result, I will be brief. It is important to note that we have strong internal controls, overseen by our board, to ensure that our spend is fully aligned with the allocations we get. We are committed to ensuring high standards of corporate governance and compliance, and we have secured and retained our ISO accreditation. We have effective and constructive engagement with the Department of Health to ensure our resources are appropriate for our remit and are used appropriately. Our budget increased by 11% on the previous year. That is a clear reflection of our expanding remit and of the constructive relationship we have with the Department.

The C and AG referenced our spend. Like other organisations, 75% of our spend goes on staff costs. We always operate within our approved allocation and all new positions are sanctioned by the Department. Our staff are committed to making a difference to everyone we serve. As CEO, I am proud and I am struck every day by the strong sense of unity of purpose, shared values and passion among our staff. We invest significantly in our people to ensure that we maintain that sense of purpose as we grow and diversify. Critically, we must continue to attract, develop, promote and retain high-calibre staff.

One of the big enablers for us as a growing organisation is digital solutions, and this is very much aligned with Government policy. We have committed to move to digital platforms to allow us to take on new functions, to optimise our research capability and to make sure that, in the regulatory space, we have real-time access to data analytics, which will inform our regulatory approach but also will allow us, between inspections, to look at surveillance of services. We all know about the threat of cyberattacks. For us, as a regulator, protecting our systems and our people against external attack is critically important. Therefore, we have invested in the development of a multi-annual digital strategy, which we hope will ensure that we are an agile, fit-for-purpose and secure organisation.

As the Leas-Chathaoirleach stated, we must be always open to improving and learning. What was broadcast on the “RTÉ Investigates” programme was truly shocking and should never have happened. I apologise again to those directly affected and to anyone who feels let down by us, as the regulator. I assure the committee that we are taking regulatory action with the nursing homes operated by this provider group. We are working closely with the Minister and the Department on those areas where the regulatory and policy framework can and should be strengthened. We are also engaging directly with families and residents.

It is also important that we look at ourselves. We are committed to strengthening our regulator role and its impact. We are also committed to looking critically at how the approach we have allows providers, in the first instance, to assess their own leadership, culture and behaviour and lets us look more closely at that, allows us to leverage the use of data through regulatory reform to support ongoing surveillance between inspections and allows us to amplify communication with the public about what we do, how we do it and areas in respect of which we can learn.

I thank members for inviting us to speak to them on our accounts but also on wider issues. I know I speak on behalf of our board and all our staff in reiterating our shared commitment to developing the very best outcomes for all who use our health and social services. We want to be the trusted regulator. We know there are challenges based on recent events but we will seek to work with all of our stakeholders to drive continuous improvement in the overall experience of people using our services. We are happy to take whatever questions members may have for us.

We will suspend for a break at 12 noon and resume shortly afterwards. I will now open to floor to members. The lead speaker is Deputy Cathy Bennet. The Deputy has 15 minutes.

I will just get straight into my line of questioning. The fact that 198 complaints of neglect were made over a three-year period in respect of Beneavin Manor beggars belief. What would have happened when complaints were made? What happens directly after a complaint is received?

I will ask our deputy chief inspector to talk specifically about Beneavin. We rely on our inspection process. We also rely on what we call statutory notifications, which is where providers are obliged to notify of us anything of concern. We will give some context on that. Second, we rely on direct feedback from staff and service users. We have a number of feeds that we assess and risk rate. I will ask Ms Cliffe to come in directly on this.

Our process is to review every piece of information we receive, assess the level of risk posed to each resident and look at what action has already been taken on foot of such information. If we are not satisfied with the action that has been taken, we can revert to the provider and request additional information. We can ask providers to carry out further work if we feel that is what is necessary on the basis of the information we already have. We can schedule an inspection on foot of that or we can align it with the rest of the information we have about a centre and use it in a line of inquiry for an inspection that may be already be planned for a centre. The final thing we will do is look at the information. If it makes reference to areas outside our area of expertise or our regulatory powers, we may look to refer that to other authorities, such as environment health officers, the fire authorities, the Garda or the Health and Safety Authority, if that is what is relevant.

How many times has HIQA referred instances of complaint to the Garda or other agencies?

We look at transfer of information to external agencies in two ways, one of which is under information that is specific to the protected disclosure process. In 2024, we had 34 referrals from that process.

In 2024, 28 referrals were made to An Garda Síochána, two to the Department of Social Protection, two to the fire authorities, one to the Food Safety Authority of Ireland and one to HSE adult safeguarding.

What happened after the referrals? Were the nursing homes involved closed?

No.

They were not closed.

They would not have been closed.

What is the role of HIQA? Does it not have authority to close nursing homes?

We can close nursing homes.

Why would they not be closed if they are not applying rules and regulations in the correct manner?

We would not close a nursing home unless there was absolutely no other option and we had no hope that the registered provider involved would be able to deliver quality care to the residents. We have a pyramid of escalating regulatory engagement that we use. Where incidents arise, we have a cautionary meeting with a provider. Our first step is probably to give feedback and say, "You need to get this sorted." If that does not work-----

That obviously has not worked. This issue is ongoing. HIQA has been in place since 2007. How many nursing homes have been closed in that period? Ms Fitzgerald stated that HIQA sets standards. What standards are being set if nursing homes are the subject of reports such as the one broadcast by RTÉ? Does HIQA have enforcement powers? What is happening? Nobody is running scared of the fact that HIQA is going to carry out inspections. That is because nothing happens and there is no enforcement after HIQA staff visit a nursing home and find that it is not compliant.

It is important to distinguish. We do close nursing homes. We have given some-----

How many has HIQA closed?

In 2020, we closed two. In 2021, three nursing homes were closed on foot of action by the chief inspector. One was closed in 2022. Three were closed in 2023. A total of ten notices were issued in 2024. Of those, seven homes have closed and one case is still under appeal. In 2025, one nursing home has closed on foot of proceedings that were instigated in 2024. What that shows is that where we cannot be satisfied that registered providers will take action to keep residents safe, we will use the law and the legal framework available to us. However, we are very conscious a nursing home is home to residents - to a large number in some cases - so decisions like that are only made as the last option. We will work with providers in the initial phase, requiring them to deliver the quality of care they are being funded to deliver.

Has Beneavin Manor been closed?

Beneavin Manor is still open and registered to operate.

It is still open-----

Yes.

-----even after the disclosures in the RTÉ programme?

Yes, it is.

It is important to note that we have stated publicly, both on record and in the report we have made available to the committee, that while our regulatory inspections identified areas in relation to staffing, supervision and the poor training and qualifications of staff - and these were part of why we were in escalation - at no stage through our inspection process did we witness anything that was witnessed in the programme. If that was ever witnessed by our staff-----

Then maybe HIQA's inspections are not thorough enough.

That is a fair comment. Are we doing enough? Do we see enough?

What was evident from some of the footage is that some staff knew that this was the wrong thing and chose to do it. There are limits in terms of what an inspection process will do. We have been trying to look at two or three things. The second is that we are in an escalatory process with both centres, but with the group as well. There is a programme of inspections under way. We have applied some restrictions to admissions. The latter is one of the safety mechanisms implemented in order to allow the staff who are available to deal more appropriately with the number of residents in a facility. We will take action. We are obviously in the process of doing that, but we cannot comment on what those actions will be.

It is fair to ask if the inspection process reveals enough. That is a question we are confronted with. We are looking at it in a number of ways. First, in the context of the regulatory powers. Second, there is the question of surveillance data. For example, I refer to the routine information that was relevant in respect of Beneavin was the level of turnover of staff between inspections and regarding the change in the profile of residents. That information is not currently statutorily made available to us.

My time is running out. I have just a few more minutes and I have a number of other questions to ask.

HIQA was formed in 2007. Therefore, it has taken almost two decades for it to realise that the existing inspection process is not working. Obviously, it is not working if RTÉ staff can walk into a nursing home and get camera footage. Are inspections always notified or can inspectors just walk in? Are the operators of facilities always not notified?

I will answer that. Our inspections are not always carried out on a walk-in basis. For example, in 2024, in the nursing home sector, 84% of our inspections were unannounced.

Should they not all be unannounced? Should inspectors not just walk in and see the real picture?

Often, that is the question asked of us. A percentage of inspections are announced, for various reasons. One reason is that in the context of renewal of registration, we may need to access particular personnel, management or staff. More importantly, announced inspections allow residents and their families to know that we are coming and to engage with us. A small percentage of our inspections are announced, but the majority of them are unannounced. All of our risk inspections are unannounced.

Is HIQA confident that next year there will not be another RTÉ documentary? I am sure that when was HIQA set up, it was to ensure that something like this would not happen. It has happened, and that is why-----

It is important that we acknowledge the challenges that were presented by this and that we look at how we can continuously improve. It is also important to say - and this is not just us because it is evidenced by the lived experience - that if you look at the overview reports that were published, which looked back at disability and older persons, there has been a demonstrable and sustained change in the lived experience of those in residential care. I have been in that situation with my parents and my in-laws, and I know how big a decision it is for families to make. We know the position, both directly from a very significant number of families and from a number of different input. When things go wrong, it is important that we take stock and look at regulatory changes and at changes in how we do our work.

I find it hard to believe, after 20 years of HIQA being in operation, that something like this could still happen. That is difficult to understand.

It was reported in the media that a particular IT project is running behind schedule. How much has that project cost?

As the C and AG stated, we have been approved for a significant digital transformation project in respect of our regulatory system.

What is the cost?

The total cost is €8.6 million.

Is it in operation?

We are moving towards implementation. We have the foundation built and tested. It works. We are working entirely within the budget. It is a fixed-price contract. We have very strong internal controls. We have had a delay, so we had to invoke some of the levers within our legal framework to drive performance. However, we now have a solution.

When will the system be up and running?

We are moving towards implementation on a phased basis, starting later this year, in healthcare - we will be starting from quite a low base from a technical standpoint - and in children services. We will move towards extending the project into next year and the year after.

Is Ms Fitzgerald confident that the project will be operational?

Yes, we have the foundation tested. The progression testing, which is very specific, shows that the system has worked. We have also had strong engagement with the provider to drive performance.

Who is the provider?

The provider is Kodak.

Has HIQA discussed the use of Kodak with the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation or the Office of Government Procurement? Did they recommend Kodak to HIQA?

No. We went to-----

We had a competitive dialogue process that we ran about two or three years ago. We set out what our specifications were and went to the market with that.

Who told HIQA what it needed exactly? Did it request help from the Department of public expenditure and reform or anybody else to make sure it was getting the right IT system?

Before we signed the contract, we had to make a business case to the Department of Health and the Office of the Government Chief Information Officer. We set out in very specific detail what our requirements were and how we wanted to meet those through a software system.

Does HIQA have full confidence that this system will be fully operational starting this year?

Yes.

I am happy with that. Hopefully if representatives from HIQA are back in again next year, the IT system will be fully operational and the €8.6 million spent on it will have been put to good use.

We have not paid anything in excess of the approved amount to the vendor in respect of the project because we have used the levers within a fixed-price contract to deliver performance.

It was reported in the media that it was running well behind schedule. Is Ms Fitzgerald saying that is not the case?

It is running behind schedule because it has been a challenging project and part of-----

It is certainly behind schedule time-wise.

When was it supposed to be operational?

We are just over 12 months behind where we should have been.

When will it be operational?

We are expecting the initial parts of the system to be going live before the end of the year.

My last question is on HIQA's income and expenditure. In 2009, it had expenditure of just €24 million but in 2023 that had increased to about €39 million. Why is there such a difference in expenditure in those years? Why has so much more money been spent?

It would be driven primarily by headcount. We have had a significant increase in the number of staff employed in the organisation.

HIQA had more staff in those years.

Yes.

We had an 11% increase between 2022 and 2023 in our funding allocation. As we set out in the opening statement, there are three sources of funding. We get the block grant from the Department of Health. We also get fee income and then we have funding for specific other projects, including funding for IPAS. The 11% increase in funding is directly related to both Departments' requests to us to take on a significantly expanded remit and that has continued into 2024.

Just on-----

The Deputy is over her time.

Regarding the income, does HIQA still receive the nursing home expert panel grant and the international protection accommodation grant?

Yes.

The nursing home expert panel grant was specifically for Covid-19. Why does it still receive that?

The decisions on the continuation of that are made without us. What I can tell the Deputy is how it is being deployed. As a result of Covid, we engaged with the Department on specific requirements that would enhance our regulatory role coming out of Covid. One of those was in relation to infection. As was set out in the more detailed opening statement, we were mandated to do two inspections over a three-year period. The Covid expert panel funding allowed us to increase that to one inspection a year. In practice, about 40% of our nursing homes are inspected at least twice and many of them far more frequently. It gave a much more stable funding base to allow us to extend our regulatory lens in those areas.

The other piece that was funded is that there was a request to look at extending the care experience programme, which is a collaboration between three organisations. We looked at the end-of-life survey which was very relevant in the context of Covid. That survey is funded from that funding to us.

Perhaps that is something other members might take up.

I thank all the witnesses for attending. Ms Fitzgerald mentioned her own experience of care with her parents and her in-laws. She did the same when appearing before the health committee, presumably to demonstrate she is a real person with empathy and a level of understanding. Would she be happy to have any of her loved ones in an Emeis Ireland-run nursing home right now?

I think the first thing for me when I made the choice to look at anywhere is you look at what are we saying about it. That is an important piece. You also look at your own requirements in terms of your loved ones. What I can say is that the two nursing homes in question have a lot of work to do. They have restrictions on their admissions. They have a very strong compliance requirement coming out of the compliance plan. They have significant work to assure us that they have the necessary management, leadership and capability and we are not satisfied yet.

Therefore, Ms Fitzgerald would not put her loved ones in those two nursing homes. Emeis Ireland currently operates 23 other nursing homes. Am I right in saying that HIQA has taken a decision not to allow any further entrants into the 25 nursing homes that Emeis Ireland runs?

That decision was taken by Emeis itself in discussion with us. As the Deputy knows, we have no regulatory role vis-à-vis Emeis as an entity. We do have with each of the individual providers. Through discussions with the chief inspector and the deputy chief inspector, it took that decision. We are in a programme of inspection by agreement with the Minister and we will make a separate and independent decision about whether that restriction should remain in some or all of them.

It is important to say that I went to the two nursing homes in question and met with a very significant number of residents and their families. We spoke at length with residents who were able to talk to us about their own experience. Notwithstanding what we saw, and I am not in any way trying to minimise what we saw, a number of residents who had the capability were able to tell us their direct experience and many of them had very good experiences, as had their families. We need to tackle what we saw but we also have to acknowledge that some aspects of care were, and continue to be, good.

As matters stand, in terms of the group I hear what Ms Fitzgerald is saying in a regulatory sense, but obviously this group has suffered enormous damage to its brand, credibility and trust. Would Ms Fitzgerald be confident having any of her loved ones right now in a nursing home in the Emeis Ireland group? I think she sort of said she would not be happy having her loved ones in the two nursing homes that were subject of the "RTÉ Investigates" report. Am I right that she said that?

No, I think what I said was that the two nursing homes in question have significant work to do to assure HIQA that they can meet the standards consistently. It would be inappropriate for me to comment on every single one of the other nursing homes because we are in programme of inspecting them.

Ms Fitzgerald is at the public accounts committee, a public committee. The public out there just want to know. HIQA is the regulator. If people working for HIQA are not satisfied to put their loved ones in an Emeis Ireland-run nursing home, how can the public be satisfied that they can safely put their loved ones in an Emeis Ireland-run nursing home? It is a fairly simple question. Given everything that Ms Fitzgerald knows - the representatives of HIQA have better information than anyone else here does - would she be satisfied to put her loved one in an Emeis Ireland-run nursing home?

What I can say about Emeis is that in my direct engagement with it and in our direct engagement as a regulatory team, it has demonstrated a strong commitment to address the issues. It has demonstrated that by taking necessary actions, which were not imposed on it. We can say that we see very significant challenges in terms of maintaining the management and other capabilities in two of the nursing homes. We are in the process of looking at a number of other ones. We will be happy to provide a comprehensive report to the Minister on our overall assessment when that work is done. We have an obligation to the nursing homes concerned to be fair to them and not to pre-empt that.

Ms Fitzgerald said at the health committee that the first time she saw footage of what took place in the "RTÉ Investigates" programme was in fact when the programme was aired. Is that right?

That is correct.

I am not trying to be personal about this, but where did she watch that programme as a matter of interest?

I watched it at home.

I am not trying to put personal accountability on Ms Fitzgerald, but she is at the top of this organisation. When she was sitting on the couch watching it at home, how did she personally feel watching that, leaving aside all the legalese and regulatory structures? She mentioned her in-laws and her parents. How did she personally feel watching that?

I can tell the Deputy very honestly because Mr. Colfer and I had extensive engagement during the programme and after it. I was shocked and appalled and felt let down by the provider in terms of what I witnessed. I also felt deeply saddened that staff did not have the skills, experience and insight to see what they should do.

For me, as the regulator, I do feel a sense of accountability. That is why I am here today. The Deputy spoke earlier about the levers. It is important that we have regulatory levers and it is also important there are standards in relation to minimum staffing. It is also important that we look at what we can do between inspections. To go back to Deputy Bennett's comments about looking between inspections at what we can do, there are a number of things to be done. However, at a human level, I was shocked and appalled.

Had Ms Fitzgerald ever seen anything worse?

No.

In her entire time as-----

In the sense that I had never seen the type of behaviours, and I think my colleagues, as inspectors, would never have witnessed the behaviours there. We said earlier that the type of behaviours that were witnessed on the programme are linked to a specific lack of understanding and a lack of insight in terms of culture.

If someone making a difficult decision and looking at nursing homes in the area in which they live were to learn that one of them was an Emeis Ireland-run nursing home, Ms Fitzgerald will understand the fear that person would have of putting their loved one, whether a child or partner, in an Emeis Ireland-run nursing home, having watched the programme.

It is fair to say that everybody who has a loved one in a nursing home-----

No, this is very specific to Emeis Ireland. The RTÉ programme was the worst thing Ms Fitzgerald, as the head of HIQA, has ever seen. How would someone in that position feel? She will understand the fear they would have.

I think we can all understand that fear. That is well established. We have to be fair. There are 23 individual providers which are part of the Emeis group. They are being subject to a programme of inspection. Each of those will be evaluated and then we will be in a position to say what is required. That does not mean that people cannot have a view right now based on their own experience of what they witnessed. However, as a regulator, we have often been challenged for taking decisions in relation to the closure of nursing homes in specific areas. We have to be proportionate here. It is very appropriate that I give a human response, because I am a human, but it is also important, as the regulator, to give a proportionate response, which is to say we have a job to do, a programme of work is under way and we have agreed to give that report to the Minister. We are giving her the reports as we continue. That will inform appropriate regulatory action.

Is the problem not that the inspections regime in relation to the two nursing homes that were the subject of the “RTÉ Investigates” programme fundamentally and catastrophically failed, to such an extent that the actions Ms Fitzgerald witnessed in the TV programme were, as she just said, some of the worst things she had ever seen? Notwithstanding the regulatory regime we have in place, it catastrophically failed those residents who were subjected to abuse and this has called into question the entire inspection regime that HIQA operates and whether it is fit-for-purpose. Does Ms Fitzgerald accept that is the natural consequence of the “RTÉ Investigates” programme?

I accept that when something occurs, as we have witnessed, it demands a response. I have outlined what that response is. We have agreed with the Government and the Minister what we are doing, which is three things. We are looking at what needs to change in the policy and regulatory framework; what action needs to be taken in relation to each of the nursing homes under that group, and that is under way; and what changes would enhance our ability, in terms of inspection and outside of inspections, to do our job.

Does Ms Fitzgerald think HIQA’s inspectors are good enough? Are they sufficiently qualified to do what they are supposed to? What are their qualifications? Do they all have nursing qualifications or gerontology qualifications? Has HIQA looked at that in terms of the people who carry out HIQA inspections?

I am very satisfied that our inspectors are of the very highest calibre. They all come from very significant clinical-----

That is not being changed.

No.

I thank the witnesses for being here. Their opening statement and contributions have been very informative, I appreciate that. I will start with Mr. Colfer. Is it correct that he, in his role, has powers of prosecution?

Yes, we have powers of prosecution.

Mr. Colfer does in his role.

Yes.

Given the experiences and reflections we have shared on the two Emeis properties, why are they still open?

We have not yet finalised our decisions in relation to any of the recent events. We are looking at the information available to us. We have engaged with RTÉ to get its video coverage so we can review that. We are still in a process of looking at-----

There is still potential that those properties could close.

-----what action is appropriate and can be taken.

How many Emeis sites has HIQA visited since the RTÉ documentary was aired?

How many?

How many Emeis sites?

There are 25 in total. Since the programme, we have inspected 16 of them. We are in the process of issuing our findings to the provider. Under the Act, the provider has 21 days to come back and correct any factual inaccuracies or challenge our findings. We have a programme of work to visit the rest of them which is very active.

To carry on from Deputy Geoghegan’s point about the calibre of the inspectors, I have a query about the nature of those inspections. How many night-time inspections does HIQA complete? What would be the percentage, roughly?

In general, our framework allows for day-time inspections. However, where we have information of concern, we do undertake out-of-hours inspections. In 2024, I think 24% of our inspections were out of hours. It is one of the questions we are examining ourselves in relation to perhaps having a more scheduled approach to a 24-7-type of inspection. We are very conscious health services are operating on a 24-7 basis.

Would the 24% of inspections that were out of ours have all been unplanned? The providers would not have been given notification that the inspectors would visit at, say, 9 p.m. or 10 p.m.? They would all have been unplanned? They were done on foot of a concern.

Normally, when we have an out-of-hours inspection it is because we have received information and we want to go out and check against that information.

That information might come from a resident or a resident’s family or would it have to be from the provider itself?

Yes, or statutory notifications that a provider has made to us that we are concerned about.

Looking at the 2023 accounts, will Mr. Colfer elaborate on what seems to me to be a real reliance on agency staff? An average of €1 million has been spent each year over the last ten years on agency staff. Are they specifically investigators?

No.

Who are the agency staff?

We have 450 staff. On average, at any one time, we would have about 15 staff on agency. For the chief inspector, and inspectors, we are precluded by law from using anyone other than a permanent employee, so no inspectors are employed on an agency basis. However, like all organisations, where we have short-term absences in critical functions, typically in operational areas such as payroll or in areas where there is continuity, we use agency staff for short-term absences. We had an unplanned absence in the area of risk, for example, where somebody had to take a few months out for personal reasons. It would be very difficult to recruit somebody for that piece. We provide for that in how we work with our Department. We absolutely operate within our approved envelope but our reliance on agency is about 3% of the workforce and we seek to drive that down. We would like not to have it but there will always be short-term absences that arise where they give rise to agency. Our staff are senior. The Deputy asked that question earlier. We have senior staff so the agency cost will be commensurate with the fact that we are looking for senior staff on a short-term basis.

If it is averaging out at that every year for ten years, there must be trends. Would HIQA be better served making a request for a permanent position in that role rather than spending €900,000 in one year and €1.2 million the next year? It is a trend as opposed to a one-off.

Every body, public sector and private, will have short-term absences for parental leave, unpaid leave or maternity leave.

I have given one example recently. We provide for that but we seek to keep it to a minimum. Our desire is to maintain expertise and maintain continuity. For example, if we are in the middle of a project where continuity is essential, it may be that we would support that project. In the CHI review where we used our own staff, there would have been an administrative piece that may have been additional, and rather than displacing someone, we would have used agency staff for a period. They are very much short term, but one would have that every year. On a base of 4,509 staff, it is somewhere between 3% and 4%.

As to that expertise, to what extent does HIQA have staff on the payroll with ICT expertise?

We have three types of arrangement for ICT. We have permanent staff. We have a small team of staff numbering about 20. Like most public sector organisations, we also have a helpdesk support function. Typically, that is outsourced because we would not have that expertise or be able to recruit that expertise. That runs on a 24-7 basis. For specific projects, which we are doing under our digital strategy, we would buy in expertise because we simply would not have that. Having that expertise available to us is essential in terms of being able to manage external contractors and hold them to account. We use it wisely. We work very closely with the Department around the use of it and we seek to keep it to a minimum. We have seen some changes in the market arrangements. We have seized that opportunity. For example, we had 97 applicants in a recent competition that, if held 18 months ago, we would not have got a candidate. Where we can, we seek to recruit people. We want to build that capability. We are in discussions with the Government about taking on a role as the competent authority for cybersecurity. Having that capability available to us is really important. However, we also recognise the public sector rates will not always allow us to buy it at the level we need.

I accept that. With that assertion, does Ms Fitzgerald think the market has changed? For 2023, there were 55 incidents of purchase orders for ICT or consultancy services in that 12-month period.

Some of those consultancy services would be for contractors delivering programmes of work. We talked about the digital strategy earlier on. In its five years, we have delivered over 100 projects that support infrastructure in terms of keeping the lights on in technical terms, ensuring that systems talk to one another and leveraging those systems from a cybersecurity point of view. We have 24-hour surveillance for cybersecurity. A lot of those purchase orders relate to that space. I agree with the Deputy that it is important that we have the internal capability. With the support of the Department, we are looking to repatriate some of that cost into our core budget.

We acknowledge that HIQA is being proactive in that regard, but it just does not seem to be sustainable. There is such a diversity, with many different companies and bodies doing what appears to be, in simplistic terms, similar work. Is there any potential conflict of interest in the organisations and companies HIQA is hiring? Everything is going through appropriate procurement processes. If there are former board members or board representatives that are now members of these companies, is there anything to be concerned about in that regard?

We have a conflict of interest policy. Through our procurement process, we are obliged to look at that as well. Any companies we take on are also bound by conflict of interest policies. For example, where we procure a legal service, the provider has to declare for each project or every initiative we are doing whether there is a conflict for it. There are obligations on providers and us.

When there is a former board chair that is part of a company that is part of these consultancy services, that provider is going through a transparent process.

Completely. Every item the Deputy instanced will have gone through a competitive procurement process, and as part of that, we will have sought declarations of conflicts of interest. They would have been identified and dealt with as part of the competitive procurement process.

I thank the witnesses for attending. HIQA has an incredibly important role in our society. It protects all of our loved ones, or at least it is supposed to. I hope HIQA leaves today with a renewed vigour to ensure safety and the highest standards across our nursing home sector and all health service providers. As an entity, HIQA has huge potential but we have to have a serious conversation today about what has happened, what has come to light and where we are going from there.

I want to pick up on Deputy Farrelly's point. According to the purchase orders, over €500,000 was paid on ICT contracts in 2024 to a company whose managing director had been the chair of HIQA between 2013 and 2018. Are the witnesses aware of the relationship between the company and how its managing director was the former chair of HIQA?

We are, yes.

Do they believe that is an acceptable level of risk or is that relationship too close?

The year 2018 was a long time ago. The procurement of the services the Deputy referred to, which were mainly in the area of cybersecurity, occurred many years after that gentleman resigned as chair of HIQA. There was a long period in between.

Was there a conflict of interest declared, given that that person may have had close relationships with people still at HIQA from the time when he was chair?

I cannot say. I was not involved in the procurement process.

We work very closely with the Office of Government Procurement in carrying out any appointments for procurement. I am not aware of any relationship. It is a very specialist area. It is cybersurveillance. It was done through a competitive process. I am not aware of any relationships current or prior to that. I have absolutely no relationship-----

I know, but Ms Fitzgerald can imagine how, when the public hears that the former chair of HIQA is the managing director of a company that now makes hundreds of thousands of euros a year providing ICT services to HIQA, people need reassurance that there is no close relationship and every accountability is in place.

None of us on the executive has any relationship. I do not actually know the gentleman at all. I know that the service provided by BDO - I believe it is BDO that the Deputy is speaking about - has been essential for us. BDO has a 24-hour surveillance service that has picked up a number of potential threats to us. The procurement was done through an entirely open process.

Are the witnesses proud of HIQA's procurement track record?

Yes.

Yes, we are. Look at our accounts. Like all State bodies, we have an obligation to publish any non-compliance with procurement regulations. There was none identified in 2023. There were no issues picked up by the Comptroller and Auditor General that year. We also had internal audits of procurement.

There is a reason I asked that. Witnesses can correct me if I am wrong. I am looking at the description of the purchase orders and the number of purchase orders from top to bottom across the entity. There were eight purchases orders, with the description "mobile phone charges", of over €512,000. I want to check that is correct and over what time period that would have been.

It does not sound correct. I have a breakdown somewhere of the actual costs we ended up spending on telecoms.

We have published our telephone costs in the statutory accounts, under the note on support costs, and this comes to €196,000 in total.

That is for that set of financial accounts.

The statutory accounts.

Okay.

There is also the breakdown of the mobile costs for the year. The cost for the full staff amounts to €115,000. It is not insignificant but, obviously, not anywhere like that number suggested.

In the constituency I represent, there are many smaller nursing homes. They might be family-owned businesses and they take great pride in the work they do. There is a big concern that if a smaller provider were to put one foot out of step, HIQA would be down on top of it making sure everything is compliant. There would be recommendations for that provider and an inspection and a report. However, more than 200 complaints were made about Beneavin Manor and a statutory investigation was not initiated before the RTÉ exposé. I can only imagine that if there was one complaint about a small nursing home down the country, HIQA would be down on top of it. Now, we see 200 complaints in this case and no action. How do we explain this?

We have one assessment judgment framework, one set of care and welfare regulations and one set of registration regulations. These are applied regardless of whether a registered provider is public, private or voluntary, or whether there are 185 beds, 120 beds or 20 beds. The same regulatory framework is applied across the board. When our inspectors arrive to inspect a nursing home, it is immaterial what the provenance of that provider is and whether it is public, private or voluntary.

Do inspectors choose what inspections they take?

Each inspector has a caseload and is responsible for ensuring that centre-----

If I am an inspector, therefore, is it easier for me to go and inspect the small nursing home where there are one or two complaints than to go to the nursing home where there are 200 complaints? Do the caseloads where there are 200 complaints get left until last because it is known it is going to be the hardest work?

No. Each nursing home is inspected according to the requirement to inspect, at a minimum, once a year, do an unannounced inspection once every three years and inspections in response to risk. For example, one nursing home last year was inspected nine times in response to the level of risk reported, notified or we were aware of. It does not matter. There is not a different framework for nursing homes that operate under the umbrella of a group, as a stand-alone provider or under an organisation as big as the HSE. It is the one regulatory framework.

Is it HIQA or the chief inspectorate that decides when there will be a prosecution or that legal action will be pursued?

That decision rests within the office of the chief inspector.

In the office of the chief inspector, if it is decided that an entity will be pursued, is the Chief State Solicitor used or are external legal firms used?

No. We have internal legal advisers and they will decide whether we need to retain extra external legal expertise as well.

In the last few years, who would have been the office's go-to legal adviser that would have done the most work for it?

Our go-to legal adviser for the office of the chief inspector would have been a company called Beauchamps.

What is the chief legal firm HIQA goes to?

Our legal services are procured for HIQA. We now have two legal firms, and we can speak to this separately, but it is done through a national procurement process.

I would just like to get the name of the firms.

To clarify, the contract with Beauchamps ended part way through last year. We went back out to the market and procured two other providers.

What is the largest provider at the moment?

We have two providers. They provide services under separate arrangements. We have Mason, Hayes and Curran LLP and Byrne Wallace Shields LLP.

Would I be correct in saying - Ms Fitzgerald can tell me if I am wrong - that Mason, Hayes and Curran is also advising Emeis?

I cannot confirm that, but what I can say is that, for example, most of-----

There were media reports in the past 12 months that would have confirmed there was a relationship between Mason, Hayes and Curran and Emeis. Now, it is also the biggest legal advisers for HIQA-----

It-----

-----and we have not seen any prosecutions over Emeis yet.

So-----

I do not want to think that HIQA has the same legal advisers as Emeis. If we have separate legal advisers, at least there is no cross communication. I just want to make sure of this.

Previously, we had a single firm of advisers. We now have two firms of advisers. As I said in response-----

When did HIQA get the second firm?

We got the two firms in response to a recent procurement process last autumn.

Can Ms Fitzgerald confirm HIQA's independence legally from Emeis?

Yes, absolutely.

How can that be confirmed?

If we were taking action-----

Deputy Dolan is over the time.

I know. I thank the Leas-Chathaoirleach. This is my last question.

-----Mason, Hayes and Curran would be formally obliged under its own rules to declare a conflict. If that conflict was declared, the firm would not be involved in-----

I assume HIQA would only take action off the back of the firm's advice?

No. We actually have our own internal legal advice. Most of our advice is framed by our own legal advisers. We have four legal advisers.

Go raibh maith agat. I thank Deputy Dolan. I call Deputy Ardagh.

We know HIQA was established in 2007 to ensure service users across residential settings live in dignity, in a clean and safe environment, with purpose and in high-quality accommodation. The most important people in the picture are the service users across the country, whom HIQA and we serve. Following on from Deputy Dolan in relation to the failure to prosecute, why have no prosecutions been brought? I know HIQA can only prosecute summarily in the District Court and it cannot issue fines. How many prosecutions have been brought in the last 12 months against individuals or nursing homes using the limited powers available to HIQA?

I believe it is two in the-----

In the last 12 months, we have not prosecuted any registered provider. Where we have situations of serious concern about the care and welfare of residents, we will go straight to the cancellation of the registration of the nursing home. If we were to issue prosecution proceedings against a provider, we would potentially be allowing the situation in the nursing home to continue while that prosecution was going through the courts. If we are so concerned about the care and welfare of the residents, then the appropriate action is to cancel the registration or to take one of the lesser regulatory actions, such as perhaps attaching a condition to stop admissions to the centre or attaching a condition to require it to have something in place in the designated centre. The most important people in the picture are the residents in the nursing homes. Our focus must always be on what is going to effect the quickest change and ensure they are safe and get the care they deserve to receive.

There is nothing stopping HIQA prosecuting and stopping a registration. Is this correct?

The legal advice is that it would be very difficult to secure a prosecution-----

Does the law allow HIQA to do both at the same time?

Technically, it does, I guess.

I thank Ms Cliffe.

The legal advice is that it would be difficult to secure a prosecution when the registration had been cancelled, as the law is grounded on a registered provider. If the registration was cancelled, then it would no longer be a registered provider.

The UK's Care Quality Commission, which is sort of like HIQA's brother organisation there, is allowed to impose fines and to prosecute at a higher level, either in the equivalent of the Circuit Court or High Court. Is it felt there are legislative gaps in HIQA's suite of available prosecutions? From what has been said, it seems HIQA is quite reticent in even using the summary suite of prosecutions it is allowed.

Just to assure the Deputy, we have taken prosecutions. Prosecutions are a very resource-heavy action, and the result of those prosecutions we have taken has been a very low level of sanction.

There have been no prosecutions in the last 12 months. What prosecutions is Mr. Colfer referring to?

These were not in the nursing homes sector, but within the disability sector.

Was this in the last 12 months or previous to that?

It was in the last 12 months. We do, therefore, look at the possibility of prosecution.

We weigh up how to effect change as quickly as possible. Our experience with prosecution is that it is heavily resource dependent and the outcomes from the prosecutions we have taken have been quite low.

Will the Deputy repeat her last question?

I asked how many prosecutions HIQA has made and whether it would like to be able to access-----

It was about sanctions.

And fines. Would HIQA like to be able to impose fines?

We are open to looking at any levers we can bring in to help us to effect change more effectively. We are having discussions at the moment about various options, including the possibility of fines. It is in discussion phase at the moment, but certainly we are willing to explore it.

How soon does HIQA think it might be in a position to do it? How far away is that legislation?

I do not think we can give a timeframe on that. We are happy to engage in the discussions-----

Is it something HIQA has formally asked of the Minister?

In discussions with both Ministers, we looked at the recent regulatory changes and the impact they will have. They will certainly have some impact on some of the issues raised today. We have looked at additional measures and they fall into two main categories. One is the powers-----

Does Ms Fitzgerald mind if I continue with my questions as I only have five minutes?

Sure.

I thank Ms Fitzgerald.

On the use of CCTV, the Care Quality Commission in the UK has expressed its view that more widespread use of CCTV would protect residential care users and service providers. As my friends have said, many of the drops in the level of care happen at night. That is why we need more unannounced inspections during out-of-hours times. That is where CCTV comes into play. What is HIQA's role in ensuring all residential settings, not only large ones but also small ones, are mandated to have CCTV that is accessible? It is thought in the UK that this type of legislation will be coming down the road.

The CCTV issue is not a simple one. Even if we look at the RTÉ TV programme, much of what happened occurred behind the bedroom door and there will never be CCTV in bedrooms. We have-----

In the UK, people are looking at having CCTV in those situations, especially when it comes to vulnerable children and adults, because that is where people are being cared for intimately. That is where families probably have the most concerns, especially those with a vulnerable child or adult.

We have seen a small number of situations where CCTV has been used in different services. We would look for a very high level of evidence that it is necessary and that other options have been looked at. At this point, we are not supporting the widespread blanket use of CCTV. There are issues about people's right to privacy and those issues need to be teased out before we would ever sanction a widespread use. However, within the Deputy's question, there is a more important point about the culture of a service.

I will stop Mr. Colfer. I do not mean to be rude, but I only have limited time.

How many children's residential centres have had their registration cancelled or conditions to it attached in the past five years?

We have not cancelled any children's-----

Has HIQA attached conditions to any?

I do not believe we have.

Has HIQA made any complaints?

To clarify, while there are more than 200 children's residential centres, we do not regulate them. We inspect and monitor against standards, but we do not have regulations for those centres. There are three secure children's units and we do regulate those and they are registered.

What is HIQA's policy then for follow-up inspections when there is non-compliance in any of its care facilities? For instance, if it were to refer a matter to the HSE, Tusla or An Garda Síochána, does it have a loop back from them and are there timelines for that?

Is the Deputy asking this about any issues we might identify on inspection?

Yes.

After inspection we make our referrals. Generally speaking, the other authorities or bodies do not come back to us but we follow up on the issues through follow-up actions and follow-up inspections. For example, if there is an issue around adult safeguarding and we have made a referral to the safeguarding team or to An Garda Síochána, An Garda Síochána will not report back to us, but we will follow up on the actions the provider has taken to keep people safe from that action.

If HIQA has made a referral to An Garda Síochána and it has not attached any conditions to a registration or cancelled any, how does it ensure those service users are not left in an unsafe setting?

We use a number of measures. If inspectors identify an issue on inspection, we will require the provider to take immediate action and, generally speaking, our inspectors will not leave until that action has been taken. A further measure we can use is to require a provider to set out the ongoing actions to ensure a person is safe and to submit them to us. If there is risk, we will go back and do a follow-up inspection to confirm the provider has taken those actions. We have gone back to some centres multiple times. Ms Cliffe mentioned one,-----

How many times has HIQA inspected the Emeis Ireland homes since the programme was aired?

Ms Cliffe might be able to give more specific information on that.

Two of the 25 nursing homes that operate under Emeis Ireland have been inspected since the "RTÉ Investigates" programme was aired, with plans in place for the remaining three. Of those, one has already been inspected a second time.

I thank the witnesses for joining us. It is fair to say that HIQA has appeared before Oireachtas committees several times in recent years and it is unfortunate that the same issues keep arising. With that in mind, I will tease out some of its frameworks for measuring performance, if that is okay.

Do the witnesses have a figure for how many compliance notices HIQA has issued in recent years and what is the rate of measured compliance after they are issued? How does HIQA measure that?

I will ask Mr. Colfer and Ms Cliffe to come in on the specifics, but the compliance notices were used administratively. We required people to put compliance plans in place, but the legal basis for that was only commenced at the end of February. Prior to that, in the absence of a legal lever, we issued at the end of every inspection a compliance plan and improvement requirements.

I might make a distinction between a compliance plan and a compliance notice. A compliance plan is where we have always required providers to respond to areas of non-compliance and we publish compliance levels in our annual reports. However, issuing a compliance notice is a new power that was just given to us and we are in the process of implementing it. We had an administrative process, as I mentioned in response to Deputy Ardagh, where we require a provider to take immediate or urgent action, but the compliance-----

I am trying to get at how HIQA measures the action the provider has taken. How does it set the bar and measure that the provider is meeting the bar?

When immediate or urgent action is required, we require the provider to demonstrate immediate action and either we do not leave the centre until it does, or we will require evidence within a few days that it has been taken. Providers set out how they will address compliance plans after the inspection. We then review those at the next inspection to confirm whether they have been implemented.

My colleague, Deputy Bennett, asked a question about closures earlier and HIQA outlined some figures. There were two closures in 2020, three in 2021, one in 2022 and three in 2023. Ten notices were issued in 2024 but there were seven closures and there has been one closure in 2025 to date.

That is 17 closures in five years. Is that right? Are any of those homes run by the same operator?

There is a common trend in the closures that happened from late 2023 to early 2025, not in the named provider because the majority were operated by individual companies, but a significant number of them were set under the umbrella group known as the Aperee group. Another two centres were owned and operated by the same provider. They had their registration cancelled. The remaining two were owned and operated by different registered providers comprised of the same directors.

Within that common thread, is there additional monitoring by HIQA to look specifically at those that fall under that common-thread umbrella—--

Yes.

-----and any other centres they may operate that have not gone as far as closure.

We have a system to share the learning from individual inspections. We do not go out expecting to see that because one thing is happening in one nursing home it is happening in another, but we are awake to the possibility that it may be, and we have a process through our regional management structure to share learning from inspections of different nursing homes. It may not solely be private providers. It could be the statutory provider or a trend in the sector, and we have processes for sharing that information internally.

It is very positive that HIQA has identified and is aware of that. I am really pleased to hear it is working on that.

In relation to the Emeis managed properties, there was conflicting information. It was said on two occasions that 25 of these are in operation. One person stated that 16 have been inspected since the RTÉ programme and Ms Cliffe mentioned 22.

Some 22 properties have been inspected as of yesterday evening. When the data was pulled initially it was 16, but a further number of inspections were completed yesterday evening. As of yesterday evening, that number is now 22.

Only one property has had to be inspected a second time.

Only one has been inspected a second time so far.

How many times does something have to be inspected before it is red-flagged or elevated to the next level of concern?

It depends on the issue identified. That is grounded in our assessment of the risk to individual residents in the centre. We afford providers an opportunity to address issues that are identified and expect that they will do it. The vast majority of the sector will do so. However, if we are really not satisfied and it is a repeat finding over multiple inspections that has not been addressed, we obviously will have an increasing concern and the timeframe to make the changes will be shorter. We will then move into escalating regulatory action. We will have enforcement action in the form of conditions and that will bring a shorter window. Like I said, one centre was inspected nine times last year. That is very unusual and it is really important that we recognise the vast majority of the sector takes action on foot of the findings of inspection and starts the work as the inspectors are going out the doors.

As regards the inspectors inspecting the properties, it was mentioned earlier that each inspector has a caseload. Is the caseload rotated?

Yes.

The same inspectors do not inspect the same properties.

We have a process of changing over approximately 25% of centres per inspector per year. We try to avoid that situation, both for the inspector and the registered provider, because if a person is going in the same door he or she stops seeing certain things. However, equally the growth in the size of the team over the past three years on foot of the expert panel review meant we went from four to five to six regions and that necessitated caseload changes as well. All of that contributed to the changes.

I draw attention to HIQA’s vision, strategic mission and values. It states HIQA will work to promote human rights, as well as identifying, challenging and reporting on breaches of rights in health and social care services. Given the recent revelations in the RTÉ programme, does HIQA stand over that vision? That is a very hard question to put to our witnesses but it is something people are asking.

It is a fair question. It underlines the importance of reinforcing that is our mission. Certainly for my predecessor, and from the inception of HIQA, one of the things we have driven is that focus on human rights. It is important to say that regulation provides a minimum compliance. What we have tried to do is move people towards a system where they are doing it because it is the right thing to do, rather than because we inspect them. It is an important point to make that if the system of delivery of care becomes dependent on an inspector coming in and shining a light, we will always have people doing things because somebody else is telling them to do it. What we are trying to do is get the system to do it because it is the right thing to do.

In the time I have been in the role, I have attended many provider events and events which mark particular landmarks, and what I have been struck by is the commitment of the vast majority of providers to deliver good care. It is a fair challenge to put to us. We have been challenged by the events, and we do have to make sure that continues to be amplified by the work and training we do, as well as by the learning events we promote with our own staff. We do a reflective practice event every year with all of the regulatory team where we go off site and challenge ourselves to look at where we could do better. We also do that with the provider system. I was at an event recently for all of the providers there, and many of those would have had challenges with us. There has always been a tension regarding whether a regulator can be collaborative. We believe we can. It is a fair question the Deputy put to us and it amplifies the importance for us to do the learning we are looking at for ourselves.

I appreciate that. Does Ms Fitzgerald feel that HIQA has lost the trust of the public, particularly since the airing of the documentary?

People feel there is a dent in the armour given we were the trusted voice. We would like to believe our track record in terms of shifting the dial, amplifying the issue of restrictive practices, particularly in disability, and moving people out of congregated settings, which was the work of the HSE but championed by us, will stand to us. With the work we have done with older persons where we really amplified the voice of the resident and tried to put the emphasis on what it is like to live in a setting as opposed to a task-based approach, we have been strong, but we are challenged to do better and that is the commitment we have made. That is not just about us. A lot of the discussion here is about whether we have the levers we need. That is part of it. We may never use those levers but they do act as a deterrent and as a barometer for performance.

I am out of time. I thank the witnesses.

With the agreement of committee I will take my slot now to prevent us having to reschedule the speakers list. Ms Fitzgerald stated there is a dent in the armour. The stronger phrase is that the trust in HIQA and the regulatory regime has been damaged. I have seen a particular impact because Beneavin nursing home is in my own constituency.

I wish to acknowledge the immediate briefing which the three local TDs for our constituency received from HIQA. It was useful in terms of answering the questions of people who were in contact with us. The witnesses are right; they fell into different categories. There were people who were the subject of the RTÉ programme who had questions and there were people who were not the subject of the RTÉ programme but were resident in the nursing home at the time, some of whom had very positive experiences, while others had negative experiences and had made reports to HIQA. The most difficult group for me was people who had family members in Beneavin nursing home who had passed away. They were really struggling with what might have happened.

We should not underestimate the damage that was done. There is a wider impact on other nursing home providers not named in the programme, where a general doubt was rightly raised in terms of how older people are cared for. I put those questions to our witnesses in order to get on the public record some of the answers that were given to us at the original briefing. Ms Cliffe was helpful in providing information with regard to the immediate inspection response for Beneavin nursing home. When I say Beneavin nursing home, there are actually three nursing home providers on that site, all of which are under Emeis and within the Beneavin campus. Can Ms Cliffe tell me what immediate response was taking place in terms of visits to the site?

We inspected the entire campus on the evening of 5 June. We did that because we wanted to be sure that what we were seeing in Beneavin Manor was not being supplemented by resources from the other two nursing homes on site. What we found was, in response to the programme, the three registered providers had put increased staff in place in all of those centres. They had a focus on the numbers of staff that were available.

They also had a focus on supervision. If the Leas-Chathaoirleach will recall, very often during the programme we heard "This is not the way to do it", "Close the door" and "We should not be doing this" That was not a failure of knowledge or training. It was a failure of supervision.