Áras Attracta scandal: how to stop it happening again

It would be comforting, at the end of a week of troubling revelations in the health service, to think that the appalling scenes of abuse at Áras Attracta were unique events.

Unfortunately, there is no basis for believing that somewhere, other vulnerable people relying on the care of others are not being mistreated. As appears to be the case in the Co Mayo care home that featured on RTÉ's Prime Time, this behaviour may be ongoing and systematic rather than a once-off reaction to difficult circumstances.

It isn’t possible to monitor all care situations at all times, nor is it desirable.

Yes, we could put cameras into every residential home in the State, and this could possibly pick up instances of abuse. More than likely, though, bad apples determined to mistreat their charges will find a way of doing their worst away from the cameras. After all, on-street CCTV cameras catch only a fraction of the crime that occurs.

Invasion of privacy

Running a tape on all care situations would constitute an atrocious invasion of privacy for residents and, indeed, staff. The privacy of the three women featured in this week’s documentary has been sacrificed to the greater good of exposing what was going on in Áras Attracta. Their families bravely made this decision on their behalf, though probably not without some qualms.

And if electronic monitoring were introduced in residential care settings, would it also have to be extended to schools and creches? Recent revelations about computer hacking and international eavesdropping of electronic communications point to the dangers involved here.

A more sensible proposal might be to use undercover staff where problems are strongly suspected. But as Hiqa pointed out, any evidence gathered this way might not be admissible in a resulting prosecution.

The fallout from the controversy has shown up the impediments to disclosure that exist, despite the increase in regulation over the past decade. Hiqa monitors residential homes, but isn't responsible for investigating individual complaints. In a different context, for example, it produced a report on maternity services in the light of the Savita Halappanavar case, rather than investigating her actual death.

Public watchdogs

The Ombudsman has complained that complaints were not passed on to his office, but Hiqa has said there is no memorandum of agreement between the two bodies.

Clearly, the co-ordination between the two public watchdogs could be improved.

There have also been calls for the appointment of a confidential recipient to receive complaints about alleged abuse in the sector, but this risks further fragmentation of the mechanisms of investigation.

A serious overhaul of the way all health service-related complaints are handled is needed, possibly through the creation of a single “super-regulator” with enhanced powers and full-time complaints handlers.