Ms Patricia Rickard-Clarke:

On the issue of safeguarding in particular, HIQA regulates HSE and private nursing homes but there is a huge gap. I chair the national inter-sectoral safeguarding committee which was established last December. We are formulating our strategy plan for the next five years. The key issue to have is a legislative framework for safeguarding. At present, we have the HSE safeguarding service and office, but it works very much on an administrative basis and there is a difficulty where serious issues arise because it is not on a statutory basis as nursing homes refuse safeguarding officers.

Another key factor for very vulnerable old people is an independent advocate. The national safeguarding committee would like full legislation on the need for an independent advocate. Mr. Dunne mentioned the care legislation in Scotland. We need to replicate the provisions on safeguarding in the UK Care Act 2014. The UK Mental Capacity Act 2005 provides for a system of independent mental capacity advocates for vulnerable people. They must be appointed for a vulnerable person, including an older person, particularly in certain circumstances. One of these is admission to a nursing home, residential care or an acute hospital over a certain period of time. It is with regard to their protection, care needs and serious decisions being made on their medical treatment. This advocacy is independent of everybody, which is extremely important. The Support and Advocacy Service for Older People, SAGE, tries to do this, but it is difficult without a statutory framework.

With regard to equality, we have the Assisted Decision-Making (Capacity) Act, which was ratified in December 2015. We had a commencement order on 17 October establishing the decision support service and we will ratify the UN Convention on the Rights of Persons with Disabilities before the end of the year. This all means rights and equality. For older people in particular, we do not have these rights and equality but we will ratify the convention and we have legislation which states the wishes of the person are extremely important. We have a lack of equality between acute hospital care and long-term care, and the choice and wish of people to decide where they wish to be. If we are to sign and ratify the convention we must step up to this.

Another piece of legislation coming before the Oireachtas by the end of the year to complete our obligations under the UN convention is the equality/disability (miscellaneous provisions) Bill regarding the right of people to decide where they wish to reside. We do not have any procedure at present. The European Convention on Human Rights has very clear provisions on prisoners who are charged and people who have been involuntarily detained for mental health reasons, but we have no procedures in law and are completely in breach of the European Convention with regard to very vulnerable people who are put into nursing homes against their will and who do not have a choice on where they want to live and their supports. When we have this legislation and we ratify the convention we must find the budget to step up to the mark.