Whenever there are scandals in the public service the inevitable review concludes it is down to a "system failure". It is a loaded term and suggests there is some kind of automated process that has gone awry in some way and there is no need to hold an individual or, indeed, an entity responsible. A succession of scandals in the health service have been in the news in recent weeks. Just yesterday, we learned of a further scandal in disability services in the north west. A resident was able to access child exploitation material online on multiple occasions going back to 2016. Basic safeguarding procedures seem to have been either ignored or abandoned. Vulnerable children were seriously harmed in south Kerry child and adolescent mental health services, CAMHS. Residents with intellectual disabilities in a care home in Donegal were sexually abused with impunity and a child, Grace, with special needs in the south east was abandoned to an abusive foster home. Our most vulnerable citizens, who relied on the State to protect them, were instead physically, sexually or psychologically abused, and some of that went on for decades. The abuse was not a secret. People in positions of power knew what was going on.

In Donegal, the staff and management in that care home were aware of the horrific sexual abuse being perpetrated by a resident called Brandon. Their response to the abuser was to move him to different wards where he had new victims who were non-verbal and unable to advocate for themselves. They were left to suffer for a decade. The Director of Public Prosecutions, DPP, has directed there will be no prosecutions in that case. We may never know the full extent of the abuse suffered by Grace. The State was supposed to protect her but instead it sent her to live with demons. They tortured her for about 20 years. In addition to Grace, the whistleblowers paid a hefty price. We recently learned the DPP will not prosecute any of the officials or State agencies that had a duty of care to Grace, despite the fact the Garda has recommended prosecutions for endangerment and negligence. In south Kerry, hundreds of children and their families suffered unimaginable trauma when they were prescribed inappropriate medications and it had devastating consequences both physically and psychologically. A rogue junior doctor who was not supervised or managed by anyone in senior management for years is probably going to take the fall. The system will remain intact.

All these scandals have a central feature, namely, that there is no accountability and a lack of consequences. What is the Taoiseach going to do to consign the term "system failure" to history and instead have real accountability built into the system, accountability that has real consequences, including the possibility of prosecution? Does the Taoiseach believe the lack of accountability undermines the vast majority of really good people who work in those services?

There has to be, and should be, accountability. I am not clear what the Deputy is proposing. These are very serious scandals in themselves, in terms of the Grace case and the case of Brandon and what transpired there. The Deputy referenced the south Kerry CAMHS. At this initial stage, I would put a question mark after the word "rogue". I think that is judgmental of the individual because I do not believe it is one issue pertaining to one individual. There are issues in terms of prescribing and so on but whether it was wilful or not is a separate matter. That is part of the issue. It is easy for us in the Oireachtas to make judgments but when it comes to the law, the legal system and people's rights and entitlements, it is a completely different arena, and people have rights and entitlements.

It has been an accepted premise here that the DPP is independent of the political system. It has been long argued but I do not see how we could change that. I do not know whether the Deputy is suggesting we should change the status of the DPP and that there should be a different approach. On balance and having witnessed things over the years, I would not agree with the idea that somehow the DPP should be answerable to the political system because I am not too sure justice would be done, if I am frank about it. We have to be careful about that. We can perhaps look at other mechanisms to get better insights or explanations as to why certain cases are not proceeding but that then could in itself jeopardise cases into the future because no case is ever closed and new evidence can emerge that can lead to cases being progressed. The DPP must make assessments, and the Garda must make assessments on these matters. I can understand why people are very unhappy, in that the Garda wished for a prosecution in this instance but the DPP took a view, probably looking at the entire case, and made determinations. The DPP's office is independent of Government, and rightly so.

More broadly speaking, as I have said before in the House, we have established numerous commissions of inquiry on a whole range of issues. Invariably, one is never entirely satisfied with the length of time they take and the fact they never lead to prosecutions, because of their very nature, and can, in some instances, jeopardise prosecutions, in the sense there can often be a difficulty between the case being prosecuted in the courts and any material related to that prosecution being aired in a commission of inquiry.

There are very real issues for us to reflect on and consider in respect of how best we pursue these issues between, on the one hand, trying to get the truth and the accountability question on the other.

The Taoiseach's very first line that he does not know what it is I am proposing concerns me. I am proposing that we build accountability into the system. There has been a myriad of different reports. When harm has been done, the first response tends to be about financial compensation, which is appropriate, but very often whistleblowers and people who have been harmed want more than that. They want to be sure that the same people who have failed in their positions of responsibility will be held personally responsible and will not be there to repeat those failures. We do not build those systems of accountability into our systems. It is very obvious because week after week we hear of different scandals. There is an origin for that. How can someone move an abuser from one ward to another and not think that is wrong? How can someone, for example, disregard things such as safeguarding and feel there is no accountability? Why is accountability not built into system? That is the point I am trying to get to.

I 100% agree with the Deputy. Of course, people should not be moved. What happened was very wrong and it should not happen. It is incomprehensible that it happened as recently as some years ago, which is my understanding in respect of the Brandon case. Accountability is built into systems, but people contest who is or is not accountable. People will argue and will say it is not them but somebody else. It is not that simple because people have rights and they will contest whether they are the ones to be blamed for a given situation.

There should be accountability in every system. I have said previously that we need to build up the existing structures. HIQA, a body I established when I was Minister for Health, has brought more accountability into health than any other body, some of which is pre-emptive accountability. In other words, it is getting in there, doing unannounced inspections and forcing change in the system. Many in the health service complained about HIQA in the early days, but it has driven standards higher than they would otherwise have been. The agencies responsible for standards and regulation are the ones we need to strengthen and empower.