All adults have a right to be safe and to live a life free from harm.

This is the core tenet behind Health Information and Quality (HIQA) and the Mental Health Commission's National Standards for Adult Safeguarding and one worth reiterating today, as we mark Ireland's first ‘Adult Safeguarding Day.’

‘Safeguarding’ is the promotion of people’s welfare and the assurance that they receive care and support in an environment where every effort is made to prevent the risk of harm.

It relies on people and services working together to ensure that those who avail of services are treated with dignity and respect and are empowered to make decisions about their own lives. 

HIQA’s role in adult safeguarding.

HIQA was established almost 15 years ago to regulate Ireland’s health and social care sector. We have a broad and growing remit; however, our core focus has always stayed the same: to protect people and drive improvements in the quality and safety of care provided to the public.

Since 2007, we have monitored a wide range of health and social care services across the country and we have engaged with many services that provide excellent, person-centred care. 

Unfortunately, we have also encountered services where a number of people using services, by virtue of their condition, circumstances or the prevailing culture of the service, have been vulnerable to exploitation or abuse - be it of a physical, financial, psychological or sexual nature. 

In instances where cases of abuse come to public consciousness, our collective response is always one of horror. We are horrified by the violation of trust, the abdication of responsibility and the lack of compassion shown to those most in need of support.

Safeguarding issues continue to be raised regularly by HIQA’s inspectors. In residential disability services, these include issues such as: a poor physical environment, inappropriate use of restrictive practices, a failure to assess social care needs, insufficient staff and a lack of meaningful activities. 

In older person’s services, our inspectors also frequently identify failings in terms of contracts of care, financial abuse and the absence of An Garda Síochána Garda vetting.

These conditions directly contravene the principles of adult safeguarding.

HIQA will continue to apply its regulatory powers to address breaches of regulation and of trust. We will also continue to campaign for reform of the regulatory framework, ensuring that the human rights of all people in need and receipt of health and social care services are promoted and protected.   

It is for this reason that in conjunction with Safeguarding Ireland we developed and published the ‘Guidance on a Human Rights-based Approach in Health and Social Care Services’ in November 2019 and subsequently developed online resources to assist services in implementing this approach.  

It is also for this reason that all HIQA standards have human rights principles at their core. 

The principles of adult safeguarding.

The National Standards for Adult Safeguarding are underpinned by a set of key values which should be reflected in the ways health and social care services deliver care and support.

These principles act in unison to ensure that the rights and welfare of people using services are the primary concern of the service provider. They are:

-    Empowerment: People are empowered to protect themselves from the risk of harm and to direct how they live their lives on a day-to-day basis according to their will and preferences. This requires people having access to the right information in a way they can understand, making decisions about their lives and being supported to engage in shared decision-making about the care and support they receive.

-    A rights-based approach: People’s rights should be promoted and protected by health and social care services. These include the right to autonomy, to be treated with dignity and respect, to be treated in an equal and non-discriminatory manner, to make informed choices, the right to privacy and the right to safety. A rights-based approach is grounded in human rights and equality law.

-    Proportionality: Staff working in health and social care services should take proportionate action which is the least intrusive response appropriate to the risk presented and takes account of the person’s will and preferences.

-    Prevention: It is the responsibility of health and social care services to take action before harm occurs. Preventative action includes care, support and interventions designed to promote the safety, wellbeing and rights of adults.

-    Partnership: Effective safeguarding requires working in partnership, that is, health and social care services and the person using the service, their nominated person and professionals and agencies working together to recognise the potential for, and to prevent, harm.

-    Accountability: Health and social care services are accountable for the care and support they deliver and for safeguarding people using their services. This requires transparency in the ways in which safeguarding concerns are responded to and managed. 

These standards are universal and apply to services regardless of size or setting. They are vital in promoting improvements in the quality and safety of care and support. They also help to set the expectations of people using services, the public, providers and professionals.

Safeguarding into the future.

Everyone has a right to be safe and free from harm. At certain times in our lives we, or those we love, might need help and support to achieve this. 

Over the past 15 years, HIQA has highlighted issues of abuse and exploitation within health and social services and in doing so has uncovered deficiencies in the policy and practice response to abuse. 

While we have undoubtedly had a positive impact on the quality and safety of the services we regulate and monitor, we believe that the protective measures which have been put in place by the State must be bolstered by the introduction of strong and effective adult safeguarding legislation.  

Our recently published draft corporate plan 2022-2024 clearly reaffirms HIQA’s commitment to promoting equality and protecting the human rights of people using health and social care services.  

Placing adult safeguarding on a statutory footing acknowledges the State’s commitment to adults at risk and the duty of civil society to adopt a zero tolerance approach to adult abuse.

I want to take the time to acknowledge the hard work of Safeguarding Ireland, as well as all associated organisations, in shaping and promoting the adult safeguarding agenda.

I would ask that you engage with the ‘Adult Safeguarding Day’ campaign and champion its ambition into the future. 

Phelim Quinn - Chief Executive Officer, HIQA