The Health Service Executive's fitness as a registered provider of centres for people with disabilities has been questioned by the Health Information and Quality Authority.
Renewed concern was expressed by HIQA to the HSE's management of its services in the Northwest area, two months following the publication of the Brandon Report.
In correspondence from HIQA to the HSE seen by RTÉ News, the online behaviour of a resident described as "very serious" leads the independent watchdog to question the HSE's fitness to provide services, to people with disabilities in the area known as Community Healthcare Organisation One.
In two letters from HIQA to the HSE, senior staff at the independent watchdog question the HSE's fitness to provide services to people with disabilities in the area.
One letter notes, "a very serious incident" regarding the online behaviour of a resident at one centre, which RTÉ News understands relates to a resident viewing material of child sexual exploitation online.
The regulator says it was not informed when this occurred in 2016, 2017 or in July 2021. It received notification of the most recent incident in October last year, three months beyond the legal requirement for notification.
The outgoing HIQA CEO, Phelim Quinn, told HSE Chief Executive Paul Reid that he was "seriously concerned" about the effectiveness of the surveillance, identification and management of adult and child safeguarding concerns in the area.
He told Mr Reid that HIQA was not assured that the HSE was ensuring safe quality care for people in receipt of care in the area and the HSE needed to provide assurance that actions were being taken.
In a statement, the HSE said it was important to state that HIQA informed it there were no current safeguarding concerns arising from their unannounced inspections completed in January, across all Disability designated centres in the region.
It said the correspondence acknowledged a shared concern for HIQA and the HSE regarding governance and safeguarding, including assessment of the need for and type of enhanced national oversight external to CHO1.
"This is building on significant improvement initiatives already taking place where HIQA also acknowledged progress in that same correspondence to the HSE."
It said immediate actions took place between national HSE and the Community Healthcare Organisation in the area to provide assurance, as requested by HIQA, on any immediate safeguarding concerns.
It also said it is constructing a wider governance review of Disability services which will build on the improvement work to date to continue to address HSE's own concerns and further informed by the most recent findings from the Regulator.
Minister of State with Responsibility for Disabilities Anne Rabbitte said she would like there to be an independent review into the CHO 1 Northwest region as there is a pattern of failure in the region to protect the service user and the wider disability community.
Minister of State Anne Rabbitte has said she would like there to be an independent review into the CHO 1 Northwest region of the HSE following HIQA concerns | Read more: https://t.co/0Q9qUMPaxz pic.twitter.com/YISVnKp2Dg
— RTÉ News (@rtenews) February 15, 2022
Speaking on RTÉ's Morning Ireland, she said: "I'm taking this very, very seriously. I was really shocked with the content of the letter from HIQA, but to me what's concerning is that there appears to be a pattern emerging and it's a safeguarding issue. And for the residents in the CH0 1 NW
"But where we have repeated incidents and a development of a pattern one has to question the staff’s understanding, management understanding about their roles and responsibilities around safeguarding and how to work with their various agencies".
Ms Rabbitte said she has spoken to Minister for Health Stephen Donnelly, to the Department of Health, and to safeguarding officers within social care and health and is drawing up terms of reference for an independent review of CHO 1 northwest.
The minister said the review will be led by a person who would specialise in social care and safeguarding.
"To me there's a worrying trend here in CH 1 NW that we need to get under the bonnet on it, we need to ensure that we have safeguarding first, inform us and we also need to reassure the families.
"So we need to actually deal with what is here at the moment and understand the pattern and if there's faults or failings there".
She also said she had sent the HSE a number of questions when the issue came to her attention at the end of December.
She has had some responses, but not specific responses in relation to the matter of how a resident was able to access the dark web and viewed images of child abuse online.
The minister said she has not received any satisfactory answer to this and how that person is being supported and how to ensure this can never happen again.
IASW in call for full publication of Brandon report
The representative body for social workers has said it fully supports Minister Rabbitte's call for an independent review of current safeguarding processes in CHO1.
In a statement, the Irish Association of Social Workers expressed deep concern about the rights, well-being, safety and protection of people living in residential services run by the HSE.
The IASW said it was clear that measures and safeguarding policies introduced following Áras Attracta, in the 'Grace' case, and most recently, in the 'Brandon' case, "have not appreciably changed safeguarding culture" and are not adequately protecting adults at risk of abuse.
The body repeated its call for the full publication of the 'Brandon' report and reports into all serious safeguarding failings, so that social workers, and others, can understand and learn from missed opportunities to intervene, support and protect people when they most needed and deserved protection.
Chairperson Vivian Guerin said the apparent lack of transparency and accountability surrounding repeated safeguarding failures must end.
The IASW said an independent review would be an opportunity for experts with international standing, to examine the roles and responsibilities of all stakeholders, including HSE senior management, HIQA as the regulator, service providers and frontline staff to make appropriate and effective improvements.
It added that "any final report must be published in full".
Mr Geiran said there was an urgent requirement for new governance and clinical oversight of the management of safeguarding concerns in the HSE and that a Chief Social Worker should be appointed, to act as a professional and clinical lead in response issues highlighted in the HIQA correspondence.
He also reiterated previous IASW calls for adult safeguarding legislation, including mandatory reporting of abuse, as a matter of urgency and priority.
Fundamental questions need to be asked
Inclusion Ireland has said fundamental questions need to be asked about how thousands of people are supported in disability services across the country.
The advocacy organisation for intellectual disabilities says it has repeatedly called for safeguarding legislation which will increase the rigours of reporting obligations in services.
However, it says legislation is not enough.
CEO Derval McDonagh has expressed the need to move from institutionalisation and institutional thinking, which she says removes power and choice from people.
She said that amid wider calls for inquiry and learning, there is an opportunity to change how the system works for people with intellectual disabilities.
"The only way to live a life free from abuse is to have choice and control over where you live, who you live with and how you live," she said.
"These are the freedoms we all take for granted, but are sadly not available for many people with intellectual disabilities today."
