Official Report: Minutes of Evidence

The Deputy Chairperson (Mr Donnelly): I welcome the following representatives: Rosaline Kelly, senior nurse in professional practice at the Royal College of Nursing (RCN); Dolores McCormick, associate director for employment relations and member services at the RCN; Mr Joel McFetridge, lead for adult safeguarding in the Belfast Health and Social Care Trust; and Ms Patricia O'Brien, chair of the regional adult safeguarding (ASG) nurse group in the Western Health and Social Care Trust. Thank you very much for coming. I invite you to make some opening remarks.

Ms Dolores McCormick (Royal College of Nursing): Chair and members, thank you for the opportunity to present oral evidence today on behalf of the Royal College of Nursing. We welcome the introduction of the Adult Protection Bill and appreciate the Committee's engagement with stakeholders throughout its development. I am joined today by Rosaline Kelly, a colleague from the Royal College of Nursing. She is a senior nurse in professional practice in the college, and she provided key evidence to our response.

The RCN represents nurses, nursing assistants and nursing students across all health and social care settings in Northern Ireland. Our members are at the front line of care in hospitals, community settings, nursing homes and people's own homes and are therefore often the first to identify adults at risk and the first to act when protection concerns arise. You have already received our written evidence, which I hope you found helpful. I do not propose to repeat that information now, but of course we are happy to respond to any of the issues that we have identified in the response or themes highlighted today.

In April 2021, the RCN responded to the Department of Health's consultation on legislative options for adult protection. Our submission reflected the views and experiences of our members, many of whom work directly with vulnerable adults across a range of settings. At that time, we expressed concern that the case for legislative change had not been made with sufficient clarity or conviction. We are pleased to note that many of the issues that we have raised have since been addressed in the current draft of the Bill. We are the only part of the UK without legislation in this area, and we welcome the introduction of the Adult Protection Bill and the Committee's scrutiny of it. We believe that the Bill marks an important step forward towards a clearer, more consistent and rights-based framework for adult safeguarding across Northern Ireland.

While our written evidence sets out our clause-by-clause comments, this afternoon I want to highlight a few key issues about how the Bill will work in practice. First, on the duty to report and cooperate, it is important to remember that there is already a professional responsibility for nurses to raise and escalate concerns about patient safety. It is a professional requirement and not an optional extra. We strongly support that clause in the Bill. However, it is vital that the duty is implemented in a way that supports rather than penalises those who speak up. It is crucial that staff feel empowered and protected when fulfilling those obligations. The success of the legislation will depend on its implementation, not just its intent. We have seen, for example, how the important provisions for independent mental capacity advocates under the Mental Capacity Act (Northern Ireland) 2016 remain dormant almost seven years later. We cannot afford a repeat of that experience. The advocacy role in this Bill is essential to ensuring that adults at risk have a genuine voice in decisions affecting them, and arrangements to establish that service must commence as soon as the legislation is enacted.

The Bill will have practical implications across various settings, including the independent sector, where many adults at risk live. Our nursing home members have expressed broad support for the Bill, but they have also stressed the need for clear guidance, consistent training and appropriate resources. The principles of autonomy, dignity and proportionality set out in clause 1 are welcome, but they must be underpinned by realistic staffing levels and professional support if they are to be delivered in day-to-day care.

Finally, we must not lose momentum. There is understandable concern about the lack of a clear timetable and the absence of detail on funding for the implementation of the Bill. The workforce will need adequate preparation and resourcing to put the Bill's duties into effect. Without that, we risk creating expectations that cannot be met in practice. The RCN supports the overall purpose of the Adult Protection Bill and is broadly content with its current drafting. It has the potential to strengthen protections for adults at risk, improve inter-agency cooperation and enhance professional accountability, but, to make a real difference, it must be implemented in a way that is timely, properly funded and achievable on a practical level for those delivering care. Central to achieving that is the development of the statutory guidance, a phase of the work that the RCN is keen to see progressing.

Thank you. We look forward to answering your questions.

The Deputy Chairperson (Mr Donnelly): Let us take any other presentations or opening remarks now, and then we will have questions.

Mr Joel McFetridge (Belfast Health and Social Care Trust): OK. Thank you. Good afternoon, folks. Thank you to the Chair and Committee members for having us today.

I am the lead for adult safeguarding in the Belfast Health and Social Care Trust hospitals, which is a nursing role. My colleague Patricia is from the Western Health and Social Care Trust and is a specialist nurse in adult protection services there. It is exciting to be involved in this and to meet the Committee and help shape adult safeguarding for the future, since it is a key role for both of us. We attend today on behalf of the Regional Adult Safeguarding Nurse (RASN) Network. In each of the trusts, there are specialist nurses working solely in adult safeguarding, and we are here to present that collective feedback. We also want to highlight the involvement of the wider nursing community — other nursing colleagues in adult safeguarding — and the important roles that they play.

Like the RCN, we will not go into our submission bit by bit, but we want to raise and protect the role of nursing in adult safeguarding, especially at this important time, when the Bill is being introduced. The need for nursing to be represented and to be very much a part of adult safeguarding was identified by the Northern Ireland Adult Safeguarding Partnership (NIASP) at the time, and, on an ongoing basis, we can see that it is acknowledged as essential. Where nurses do not oversee adult safeguarding investigations, as per the policy and procedures, it must be a social worker designated as an adult protection officer.

Patricia and her colleagues undertake the adult protection investigating officer (IO) role. They will look at the available evidence and fulfil that role, and it is nurses in each health trust who fulfil that. Therefore, it is important that they are acknowledged in the Bill. All nurses have a role to play; the Nursing and Midwifery Council (NMC) code clearly tells us that. Working in collaboration with the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) and the Public Health Agency (PHA), we produced 'A Core Competency Framework for Nurses and Midwives' in 2018. That very much sets out the core knowledge, skills and competencies that nurses must have at each level, depending on their role, to fulfil duties in adult safeguarding.

We are very much for the Bill in its current format. In focusing on the social work role, there is perhaps a risk of the nursing role being slightly eroded. That is why we want today to highlight the importance of having nursing in it too. We picked up on other things, such as the duty to report. Is that a definitive list? Other people could be included in that. I again bring it back to nurses, because nursing interventions during visits and interviews will be essential. Nurses could assess the situation from a nursing standpoint, especially during interviews, because we have the nursing training and the requisite skills to do so. When it comes to the collecting of records, if a nurse is the investigating officer, they may well be going to wherever those records may be, collecting and examining them. In keeping with what the RCN has said, will there be cognisance of the training needs of other professionals, such as nursing, during the scoping and development of associated procedures? Will there be the required funding to continue and build on the important role that nurses have?

The Deputy Chairperson (Mr Donnelly): Thank you both for that. Dolores touched on the guidance, which is, I think, mentioned in clause 22. In your view, what needs to be in that guidance for the legislation to work?

Ms McCormick: In our view, that is the piece of the jigsaw that we are most keenly interested in, as are all our nursing colleagues. The Bill clearly lays out the statutory powers that it will bring in. For us, the piece is the amplification of what that looks like on the ground for safeguarding vulnerable adults and protecting staff. The guidance must amplify some of the things that Joel articulated. How will it work in practice? The big thing for us is the capacity issue. We already work in a healthcare environment with many deficits in our resources. Training is the big thing.

I mentioned intent. We need more than the Bill; we need to have intent on the ground. It is about the training and how it is delivered and about listening to patients, relatives and staff. We are certainly hopeful or confident that that will all be teased out in the next round, when the statutory instruments and the subsequent regulations are being designed.

Mr Donnelly: Joel, do you have anything to add to that?

Mr McFetridge: No.

Mr Donnelly: Do you have any views on whether there should be a time period for the guidance to be reviewed?

Ms McCormick: Even keeping a review of the actual Act, it has to be written in a way that can be reviewed. There are certain things that might need consideration as we get into it. A review needs to be built into the system at this level, before we even get near the statutory instruments. Look at similar legislation across the UK. In Scotland, I do not know how many years later, they are still learning lessons. It has not been a panacea. It does not change the culture. A review has to be built into the system.

Mr Donnelly: What can professional bodies such as yours bring to the development of the guidance?

Mr McFetridge: We can bring expertise as people who are working on the ground and nurses who are involved in day-to-day adult safeguarding practice, be that in operational roles or strategic ones like me. We do it all day, every day. We can tell you what the issues are and what is and is not working well. We can flag those up for possible review.

Ms Rosaline Kelly (Royal College of Nursing): I woke up this morning with no voice, so I apologise. You might have to listen hard.

Building in a proper review mechanism is essential. Look at the situation that we are in at the minute with the Mental Health (Northern Ireland) Order 1986 and the code of practice. It is outdated statutory guidance that supports outdated legislation. Substantial work is being done on that, and a consultation is open on a revised code of practice. In the code of practice that is relevant to legislation from 1986, the language is outdated, as are the practices. So many more agencies have been developed since then that all have a specific role in supporting people with mental ill health and in the implementation of the legislation. We should have something formal that says, "Yes, it must be reviewed" so that it is brought up to date.

The most important thing is to have clarity about what each practitioner and organisation is supposed to do and when, what the limits of their role are and the stage at which it gets handed over to another agency, practitioner or whatever it happens to be. We can take lessons from how the Mental Health Order's code of practice has been revised and the ongoing work on the Right Care, Right Person policy. I am part of a working group that is looking at inter-agency working and how each of the agencies interacts with specific memorandums of understanding. That includes even the Northern Ireland Housing Executive when it comes to powers of entry. All of those people are involved. That really comprehensive work will set out who does what and when, under what legal authority, what their limitations are and when you hand over. Clarity is absolutely essential.

The Deputy Chairperson (Mr Donnelly): Thank you very much. There was a lot of detail there.

Mrs Dillon: Thank you for the presentation. We will definitely have more nurses giving us presentations: those were the briefest, most succinct and most easily understood presentations that we have ever had. Thank you very much for that. I really appreciate it.

You are right about the review mechanism. It needs to be built into the legislation, not the guidance. I think that you are saying that you would like to see it in the legislation. That is necessary, because guidance is only that: guidance. A review was built into the Domestic Abuse and Civil Proceedings Act 2021, and that is invaluable. We may want to tease out with officials whether we should identify who will be responsible for that review, how and when it will be done and whether it will be a rolling thing. You certainly have to give a period of time. I do not think that you could say that it should be done a year after it is put in place. That would not give sufficient time to do it. That is important.

You talked about the powers around visits, interviews, records and removal orders. They name only the social worker. From a nursing perspective, are there clauses that should explicitly — you have not said this, so I assume not, but I want to make sure that I am right — include the reference "or suitably trained healthcare professional", or should it be kept as "social worker"?

Mr McFetridge: A lot of our initial submissions were about that. We suggested "accompanied by a nurse or suitably qualified healthcare professional". In its current format, designated adult protection officers (DAPOs) are social workers, so they oversee and are the ones who will apply for the orders, be it removal or whatever. An investigating officer, who could be a nurse or another profession, might well go with them to assist.

Ms Kelly: The Bill is very social work-orientated and social work-heavy and rightly so, as they are core functions for social workers. However, as Joel said, there are specific things that registered nurses with the relevant knowledge, experience and skills will be absolutely essential in assessing and evaluating, particularly if it is a healthcare issue, rather than a social care one, that is of concern.

Mrs Dillon: Is it sufficient to have it in the guidance, or should something be changed in the legislation?

Ms Kelly: It would be helpful to have it in the legislation, worded in such a way as to be of benefit the person at risk.

Mrs Dillon: I appreciate that. I am really pleased that you talked about Right Care, Right Person, because I am on the Policing Board as well, so that is a pet one for me.

That is all that I wanted to tease out with you. It might be useful, if we were going to discuss that with officials, if RCN or a group of you sent us something specific on what, you think, that wording might look like, because the wording will be important. No one understands that better than you. We as MLAs will not understand that. You are the professionals. We need to be sure that we get that right. We may need a bit of tick-tacking and toing and froing with RCN on that. It may well be something that the Minister or the Department are prepared to put into the legislation. We might not have to look at amendments or anything like that, but, if we have the wording, we can say to officials, "This is the wording that will work for the professionals".

Ms Kelly: We will be happy to do that and work with the safeguarding nurses to get the right wording. Obviously, we will put it in a way that might need to be changed to fit with the legislative language, but we can make a suggestion.

Mrs Dillon: We can work on that, absolutely. Thank you very much.

The brevity in your presentation was much appreciated and allowed us the opportunity to ask the questions. Thank you.

Miss McAllister: Thank you very much for the presentation. I have a few questions, first of all, on the specialist nurse role. I understand that its creation in this context was not so long ago. Does the Bill protect and provide enough for the continuation of that? I note that, in your submission, you did raise some concerns around the continuation of the role. Can you outline a bit more of those concerns?

Ms Patricia O'Brien (Western Health and Social Care Trust): It is really important that the nurse specialist in adult safeguarding is included in the legislation. I work in a social services social work team. I am the only nurse across the Western Health and Social Care Trust. My job is essential in order to look at records and give opinions about whether care was not delivered appropriately in accordance with assessment and so on. That, to me, is a function of a nurse, and it is essential that we have the nurse specialist included in the legislation.

Miss McAllister: Is that for the investigative side of the —

Ms O'Brien: For the investigation, yes.

Miss McAllister: Then, for the social worker as the DAPO, should it always just be a social worker? Has that ever been touched on — that it is something that a nurse could be capable of?

Ms O'Brien: We have a function for a social worker on our team in investigations. The nurse also has a function there. They are both not only beneficial but essential in order to screen a referral that has come in to our team.

Mr McFetridge: Just to say as well, in the policy and procedures prior to this, there were nurses who were DAPOs.

Miss McAllister: So it is possible to —.

Mr McFetridge: It is possible, yes.

Miss McAllister: OK. There is another issue that I want expanded on that I do not have a great deal of knowledge on, and that is the Mental Capacity Act and how it is partially implemented. In what areas has its progress slowed and we have not seen its implementation? I was new in 2022; I was not around when that Act was being passed. What will need to be pushed forward to enable this Bill, as well as fully implementing the 2016 Act?

Ms Kelly: There is certainly overlap. There seem to be overlaps or interfaces between the powers in the Bill and the Mental Capacity Act. At this moment in time, as you say, it is only partially implemented, primarily around deprivation of liberty. I know that the Department is working on what it would look like to implement the rest of the Mental Capacity Act. It will be years before any of that gets progressed, but the Mental Capacity Act is about safeguards. Think about the Mental Health Order: it very much talks about powers, but, when we move to the Mental Capacity Act, we are talking about safeguards for the person who lacks capacity to give consent for a particular situation and safeguards for the person who needs to do something with, for or to the person who lacks capacity.

One of the safeguards was an independent mental capacity advocate, who had a key role when there was going to be a serious intervention. Deprivation of liberty is one of the most serious interventions that can happen under the terms of that Mental Capacity Act. You are taking away somebody's liberty. I understand the explanation that was given at the time, in 2019, when the deprivation of liberty safeguards were implemented. We were not in a position as a country or as institutions to have the independent mental capacity advocate role available, but, six years later, post the implementation of the deprivation of liberty safeguards, that huge safeguard that was part of the Act is not there.

We talk about prosecution, and the Mental Capacity Act already contains parts that are about ill treatment. Where is that interface? Do you identify the ill treatment first under the Mental Capacity Act and then use the powers of this Bill to proceed to prosecution or investigation? Where are those interfaces so that those who are working within the parameters of the Act and the legal frameworks know exactly what they are doing so that they do the right thing for the best outcome for the person who needs to be protected?

Miss McAllister: Thank you. That is helpful. We will probably want to explore that further with the Bill. I was not aware of that until you highlighted it.

For the full implementation of the Bill to take place, which, we know, will take some time, is it necessary to have the full implementation of the 2016 Act? In my head, I am thinking of scenarios where the advocate would have a role under the Bill.

Ms Kelly: They are two different roles, Nuala. The independent mental capacity advocate is a specific role related to certain provisions in the Mental Capacity Act. This will be a different role.

Miss McAllister: That role will, in a sense, come to an end once it has reached investigation stage.

Ms Kelly: Potentially, but what their specific role is, who those people are, how they act and how they support a person who might be at risk need to be set out in the statutory guidance.

Miss McAllister: Thank you. Finally, on clause 5 and the accompanied person, which Linda brought up, why is it so important to include the possibility to have, alongside a social worker, another qualified health professional on the visits by a social worker?

Mr McFetridge: It is a multidisciplinary approach, really. Each brings their own skill set, knowledge and values. Nursing comes with its lens, and social work comes with its lens. It is very much about working in partnership to get the best outcome for the person.

Ms McCormick: It is all about context. Nuala, you asked about the role of the specialist nurse. If we are looking at neglect or the poor delivery of healthcare, as Joel said, nursing comes with its lens. However, if you do not have the nursing lens on a particular situation, social work may come at it from a different angle, and things get blown up, maybe, when they do not need to be, or maybe they do not get blown up when they should be. It is really important to have that additional lens.

Miss McAllister: Would it have to be a specialist nurse who does that during the visits? I am just trying to make sure that I understand all the roles.

Ms McCormick: Let us say that the issue was that wound care was being badly managed. The specialist nurse might say that they want a tissue viability nurse in for a professional opinion. It is all about a multidisciplinary approach.

Miss McAllister: Thank you very much.

Mr Chambers: In the evidence that we have taken so far from different agencies, everybody seems to broadly agree that CCTV is desirable in settings where there are vulnerable people, but everybody has their own concerns and has expressed those in their evidence. I note that you refer, in your written submission, to your broad attitude to that, but would you like to expand on how you feel about the use of CCTV?

Ms McCormick: The first thing I will say, Alan, is that CCTV will not change culture.

Mr Chambers: No.

Ms McCormick: It will not change poor practice. The college would not be absolutely opposed to it. We would say that, if our health service is in such a state that we need CCTV to make sure that people are treated with dignity and respect, where are we? That is my starting point. CCTV is in the Bill, and there would need to be a lot of work and consultation. It is a complex issue, and we must just remember that, if you live in a nursing home or a residential home, it is your home: I do not know whether I would want CCTV watching me in my living room.

It will interface with human rights and touches on the deprivation of liberty that Rosaline mentioned, so it is extremely complex. If it were to be implemented, there would need to be strict governance around it with regard to where you would you put the CCTV and who would have access to it. There is also data protection.

I am not really answering your question. We have a broad view on it, but our starting point is that it will not fix poor culture.

Mr Chambers: You rightly say that it would be a shame if our health service has reached a point where we need Big Brother looking at everybody and everything. However, would you accept that, in this day and age, when people litigate over the smallest thing, it will also protect nursing staff and professionals working in those places? They are just as vulnerable to accusations that are false or have no substance. Would you accept that it is a two-way tool?

Ms McCormick: It is indeed, and we are accepting that in our emergency departments (EDs). CCTV is being piloted in the Antrim Area Hospital ED. We are accepting it, and it has a place, but that is slightly different from it being in someone's home. There is a tension between the two. It would need a lot of consultation and thinking and really tight governance.

Mr McFetridge: On behalf of our regional group, I will say that we actively encourage the use of CCTV. It needs to be undertaken in an open and honest manner, and there would need to be robust governance arrangements. I completely agree with the RCN that it is someone's home, so there would need to be consent. It could not be a blanket approach and would need to be person-centred. The RCN has its guidance on CCTV if it is done covertly. If it were going to be in an environment, it would need to be open and honest, with, maybe, signs to let people know the policies and procedures that were in place.

Mr McGrath: Thank you for your presentation. It has given us lots of food for thought. A Bill cannot be prescriptive by its nature. Where we need to be careful is that the intent of the Bill is clear, so that, when regulations or guidance are drawn from it, it is obvious what needs to be in place. If there is any ambiguity, it is often your organisations and those whom you represent on the front line who are caught between policies, guidelines and approaches. They get the blame five or 10 years later, so we need to be careful. We have the benefit of examples over the past number of years, and we should draw on those to make sure that we support staff. It is an absolute given that we support those who are in units, homes or wherever, but we must support staff as well to make sure that they take the practised decisions in the full knowledge of what they are being asked to do.

It will take £125 million over five years to start to implement some of this. Swathes of staff will be relocated out of one element of working into other elements of work. I do not want to put words in your mouth, but, if you have concerns on that front, it would be good to know what they are. We need to make it obvious to the Department that it cannot come along with a robust and detailed Bill that changes approaches and then not back it up with the right resources in staffing and finance, because, again, it will be your members who are left doing the jobs of two people or looking for help and support from allied professions that are depleted of staff. Is that a worry? Is it something that we should definitely articulate to the Department: that it needs to get that piece of the jigsaw right before we move on to the implementation stage?

Ms McCormick: It absolutely is a worry. We have safeguarding policies and processes in place; we are not sitting with nothing. We have policies and procedures, and we have people — my two colleagues who are sitting here — who work in safeguarding, so it is not a complete clean sweep. The biggest issue for us, as well as the funding issues, obviously, is that someone somewhere must take a good look at what the statutory guidance looks like and what it requires of us as regards staffing and put a cost to that. We do not want any of our members ending up, as you say, with two jobs. We will be absolutely clear with the Department that the Bill cannot hit the ground until the costing has been done. At the minute, we have staffing deficits in nursing and social work — there are huge gaps. The people who undertake the work need to be experienced people. They are not roles for people who are new to healthcare, and that needs to be built into the funding and business cases.

Mr McFetridge: Absolutely. I totally agree. There needs to be proper funding, proper training and proper guidance so that staff are clear about what is expected of them.

Mr McGrath: What is the lay of the land? Is there a fully funded resourced service at the minute, or are there difficulties with regard to resourcing and funding for the work that you have to do currently?

Mr McFetridge: There are difficulties with funding at the minute. That is the simple answer. There is increasing demand, year on year, an increasing number of referrals and more complex work. I am sure that Patricia would agree.

Ms O'Brien: Yes.

Mr McGrath: That, obviously, will be exacerbated by an ageing population. We will have more old people, more homes for old people and more people who need to be —

Ms McCormick: We have more and more vulnerable patients receiving care.

It is not all down to the health resource; there is also the PSNI and public prosecution resource. There are delays, and people are in suspense for years as they go through safeguarding procedures. There is a lot wrong at the minute that the Bill will not fix. It is a resource issue, and, as Rosaline said, it is about agencies talking to each other.

Mr McGrath: There is an increasing need for us to get this right as we realise that it will probably govern us as we get older — some sooner than others. [Laughter.]

I refer to myself; I am not looking at anyone else. I am keeping my eyes down as I pass to the Chair. I will get into big trouble.

The Deputy Chairperson (Mr Donnelly): Thank you, Colin, who had a big birthday recently. [Laughter.]

Mr McGrath: That is why I want to get this right.

Mrs Dodds: It is great that I have followed Colin, after that remark. [Laughter.]

Colin's comments have encapsulated the question that I wanted to ask. Apologies, but I took a tickly cough, so I had to go out to get some mints, which I no longer seem to need.

One thing that I find difficult to figure out about the Bill is how much it will cost to implement. There is no sufficient costing in that, and, Dolores, in your opening remarks, you referred to that. If there is not sufficient funding, you lose momentum with the implementation, so all of the good work that the Bill is intended to do gets a bit lost in the system. First, I want to get your impression of costings from what you have read. From what I have read, I have not been able to work it out sufficiently, but maybe that is just me.

Secondly, the potential is that the Minister will implement the Bill incrementally — I think that he has said that — as he finds the money to do so. Surely there are huge difficulties with a Bill that is implemented incrementally and is not fully in place. Those are my two points. You are probably the first people to mention that, but it is important to consider. Other folk had mentioned to me the difficulty with the partial implementation of the Mental Capacity Act: one bit of it is done; the other bit needs to be done but is not done, and that has created a lot of harm and confusion. Can you comment on that and the funding issue?

I agree with you about the loss of momentum. The Bill has come about partly in response to a great harm at Muckamore Abbey Hospital. On behalf of all those people and for the rest of us in years to come, we want to ensure that it is done correctly or to the best of our ability at this time.

Ms Kelly: Maybe I can talk about the partial implementation bit. I understand the concerns. I understand the explanation that was given at the time for the partial implementation of the Mental Capacity Act. It was primarily about human rights issues and people not being deprived of their liberty. There was no legal framework around that. That was for that person and for the people detaining them. We have run into difficulties because, now, we need to understand that there is no authority to provide any treatment to anybody under the Mental Capacity Act. The person still cannot give consent and say, "Yes, I would like you to help me to wash and dress, give me my medication and undertake that intervention". The statutory element of the Mental Capacity Act with regard to best interests has not been implemented, so there is no protection.

Mrs Dodds: That issue came up in a case that I was dealing with. You have mental capacity with regard to finances but not with regard to health and well-being.

Ms Kelly: Yes. That has been difficult. I know that the Department is working on a plan to see what that will look like in the future, what it will cost and what resources will be needed for it. That is a wee bit away. It is talking about implementing another piece of the Mental Capacity Act: section 12, which is on acts of restraint. That will help with some of the challenges that have been encountered because, although there may be an authorised deprivation of liberty for a person, if you need to take them to a place, neither agency knows what their authority is to do that, because that part of the Act has not been implemented.

Little pieces of the Act pop up in places where it would be really helpful if that were part of it. While I understand the explanation for partial implementation in 2019, it has not come without its challenges. The initial plan was to implement it all at the one time. I read in the Hansard report of the Committee meeting with departmental representatives that they were not in favour of partial implementation. We would support that view with regard to this Bill.

I really cannot answer the question about funding.

Mrs Dodds: That is great. Thank you. It is important that we do not have an Act that is good law but cannot be implemented.

Ms Kelly: At the minute, it is confusing for staff because they are using the Mental Health (Northern Ireland) Order 1986 in certain circumstances. Sometimes, they then have to transfer to the Mental Capacity Act. The Mental Capacity Act does not apply to under-16s; the Mental Health Order does. It is just a really murky field for people who work under that legislation. Again, that takes me back to the absolute clarity that will be required in the statutory guidance, because that is where staff will go. They will go to the guidance and say, "I need to do 1, 2, 3, 4 and 5. That is the order that I do it in. That will help me in my practice". They will not read the legislation every day. That is why I say that the clarity in the statutory guidance will be absolutely vital.

Mr Robinson: When I read through the report, my thoughts were exactly the same as those of Diane and Colin. There is a line in the report that is the best line that I have read so far in the limited presentations that we have received. It refers to the:

That sums up the fear and frustration that we all have in the room.

If we are really honest with ourselves, we all know how this will develop. In two years' time, we will see a review of the limited implementation that has been done so far. Then there will be a further review. People in this room will be pulling out any hair that they have left, fed up yet again with a Department that seems to put strategies and Bills in place that are then half-heartedly done. Some will say that that is no fault of theirs and that it is the fault of the fiscal environment in which the Department has to work. That was the question, and I suppose that you have answered it: to be fully effective and to do justice, does the Bill need to be fully funded? We all know that it will play out in fits and starts. We know that it will play out in that way.

Ms Kelly: I will just add this. The legislation is really important for people, especially those caught up in the Dunmurry Manor and Muckamore Abbey situations. It is so important to get it right for them. Those people fight every day to get what they need for their relatives. Full implementation is the way to go to rebuild relationships with those people.

Mr Robinson: I will just touch on the other issue. Do your teams or the wider nursing cohort have the training and capacity to meet the Bill's obligations? What are the gaps?

Ms Kelly: Before I let these guys talk, I say that, absolutely, nurses have the knowledge, skills, expertise and experience to do that. The ability comes with experience, the more experience you get. The support behind you of the law, guidance, training et cetera are really important. It will be important with the Bill to allow professionals to have professional curiosity and to ask questions of a situation. The Bill will be black and white — that is what law is — but, in practice, nurses also need to develop the skill of professional curiosity, which the specialist teams absolutely have.

Mr McFetridge: Nurses working in adult safeguarding have the skills and knowledge. They are well placed with the Bill coming in. With the changes, there may well be training required, but nurses are well placed.

Returning to the question of the implementation of the Bill, I absolutely agree. The best scenario is a robust Bill that is enacted at the one time and sets out the ethos of what is expected, alongside good guidance for staff. Again, I heard someone say that consideration is being given to making guidance a live document, like that of the Safeguarding Board for children. The latest version would be always on line, with the latest changes, as opposed to a document published and then reviewed two or three years later. If something significant happens, the document can be changed.

Mr Robinson: I will ask a direct question: is the Bill destined for failure without the appropriate funding?

Mr McFetridge: It will be extremely difficult to do anything without appropriate funding. Trusts are coming in, obviously, on their own behalf. However, to put that workload onto an existing, very stretched workforce would not be good. That is the easiest way to say it.

Mr Robinson: No pressure on the Department then.

The Deputy Chairperson (Mr Donnelly): Are you finished, Alan?

Mr Robinson: Yes.

Mr Chambers: May I ask a quick question? I take on board all the concerns about fragmented implementation. It may not be satisfactory, and it is not something that anyone in the room is keen to see happen. However, do you accept that fragmented implementation is better than no implementation? Would you rather that the Department said, "We will put this in cold storage until we can fully implement it and have the full funding to do it"? Would you feel that that was a more satisfactory approach than fragmented implementation?

Ms Kelly: It is a trick question because, obviously, we need the Bill. As Joel said, we need it properly resourced and fully implemented. The lessons that we have learnt from partial implementation of the Mental Capacity Act show you that one bit does not work without the other. It makes absolutely no sense to me to partially implement the Bill. It will limit what a person can do. Somebody who is given a power or the authority to act under the Bill will be able to go only so far, and that will be totally challenging and very unsatisfactory. None of those options are what we want to see.

Mr Chambers: Would you prefer, then, to call on the Department to put the legislation into cold storage until it is able to fully finance it?

Ms Kelly: I would like to see an implementation plan that is properly funded, and that is a matter of priority.

Mr Chambers: Even if that were to mean stopping the process because the Department does not have the finance to do it?

Ms Kelly: It does not need to stop the process, because this will not happen overnight. It will not be the case that, from 1 April 2026, the legislation will be in place with all bells and whistles; it will be a process of implementation. We need to have the workforce, the guidance, the policy procedures and the robust training set up before we get to a point where what will become the Act is fully operational at the optimum level. It is not a matter of saying that we will stop it and restart it in two, three or four years' time. A lot of groundwork could happen on which progress could be made while we wait for full implementation.

Mr McFetridge: The legislation is so important too. There really is the need for it, so it would not be appropriate to put it into cold storage for many years, for the reasons that we have outlined.

The Deputy Chairperson (Mr Donnelly): Thank you very much for your presentations and your answers. It has been incredibly useful, particularly to hear from professionals who work day-to-day in this area.