Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I formally welcome the representatives from the office of the Commissioner for Older People: Siobhan Casey, the commissioner; and Aimee Miller, head of legal and advocacy. You are very welcome to our meeting, where we will take evidence on the Bill. I will hand over to you to make some introductory remarks, and then members will have questions.

Ms Siobhan Casey (Commissioner for Older People for Northern Ireland): Good afternoon, everybody. Aimee and I are delighted to be here today to discuss the Adult Protection Bill. The Adult Protection Bill presents a significant and long-awaited milestone for our organisation. The office of the Commissioner for Older People for Northern Ireland (COPNI) has been calling for this dedicated legislative framework to safeguard adults at risk of harm. Establishment of the Bill was one of the main recommendations that emerged from the previous commissioner's investigation of safeguarding failings at Dunmurry Manor care home. The 2018 'Home Truths' report, which emanated from that investigation, was a watershed moment for adult safeguarding in Northern Ireland. It exposed deep systemic failures — not a single incident, but patterns of neglect, poor communication and lack of accountability across agencies.

Since then, there has been real progress: awareness of safeguarding has increased; referrals have increased; and safeguarding is now more prominent in policy discussions. However, the fundamental issues identified in 'Home Truths' have not disappeared. We are still aware of inconsistent responses, delays in investigations and confusion as to who is responsible for what. That is why the Adult Protection Bill represents real progress. However, for it to make the difference for older people that older people deserve, the Bill needs a bit of strengthening, with clear safeguards, proper resources and truly independent oversight. Otherwise, we risk the gaps that we saw at Dunmurry Manor re-emerging in a different form.

For the past number of years, my team has been engaging with the Department of Health, in a really strong working relationship, on development of the Bill. We are delighted to see the Bill finally come to the Assembly and its progress through it. My role, as commissioner, is to safeguard and promote the interests of older people. In keeping with my powers and duties, I would like to focus our discussion today on how we can ensure that the rights, interests, needs and behaviours of older people are central to the legislation.

In our written evidence submission, as well as in a detailed report that will follow in December, we have reviewed the Bill from my perspective as an independent champion for older people. I, along with my team, welcome the fact that the Bill and its provisions will be applicable to all adults across Northern Ireland. It is particularly important for older people, who, given our ageing population, will constitute a growing proportion of those impacted on. We recognise that the Bill has the potential to reshape the entire safeguarding landscape by better protecting citizens from abuse and neglect and by providing a framework for prevention, protection and accountability. Notably, by adopting this much-needed legal framework, Northern Ireland's legislation will, at last, align with other regions in the UK to ensure that vulnerable adults here receive the same protections as their counterparts elsewhere.

The fact that the Bill will provide key duties to a wide-ranging group of bodies — health trusts, the police, the Regulation and Quality Improvement Authority (RQIA), the Public Health Agency, the Housing Executive, the Probation Board and, we understand, a few others — is highly significant. Why? It is because abuse, harm and neglect can happen anywhere: a workplace, a community setting, supported housing, a care setting or the street. As we all know, it is largely unseen. Therefore, ensuring that a more extensive range of bodies is looking out for and accountable for protecting adults at risk is a major and crucial step forward by government. I would, however, like to draw your attention to a few areas of the Bill that require consideration: the duty to report, the terminology used and compliance.

The Bill lacks clarity on the consequences of non-compliance. Without an enforcement mechanism, bodies that do not comply with their safeguarding responsibilities risk undermining the very protections that the Bill seeks to establish.

As regards terminology, I know that you met the Assembly's Research and Information Service (RaISe) recently, and there was quite a discussion around the need for the terminology to be really clear and about Scotland and Wales, where the definition of "adults at risk of harm" is broad, inclusive and reflects the lived experience of the many adults who endure various forms of harm. Notably — this is a bit of a standout for us — we found out, at a safeguarding conference that we attended recently, that the Scottish adult protection experts suggest that self-directed harm and neglect need to be included in the definition. Interestingly, their figures show that self-directed harm and neglect account for 26% of their adult safeguarding cases — a higher proportion than physical harm. Therefore, it is an area that needs further scrutiny.

You will also note that, in the submission, we identify a number of issues around consent and the need for independent advocacy, which are particularly pertinent to older people. Many older people view professionals — doctors, police and social workers, to name but a few — as authority figures, and, in some scenarios, might be reluctant to question their advice. That could lead to older people complying, rather than consenting, which we believe is especially concerning, considering the powers of investigation proposed in the Bill, such as interviews, medical examinations and access to records. We all know that independent advocacy is one of the most effective rights-protecting provisions. Therefore, an advocate should be appointed in every case where there are adult-facing safeguarding processes. That would ensure that adults at risk, who may feel intimidated, disempowered or unheard, could participate fully in processes and challenge decisions made about them. Without that independent advocacy provision, which is outlined in the Bill, older people may accept decisions without a full understanding of the implications.

In summary, the COPNI team wholeheartedly welcomes the Bill. Its provisions represent positive steps forward that will protect adults at risk in Northern Ireland in line with our counterparts in the UK. We believe that some of the provisions need to be tightened to ensure that older people's voices are heard, their preferences are considered and their rights are upheld. Older people are not and must not be passive recipients of care and protection; rather, they are partners in shaping their care and protection. Older people are not a homogenous group: the law must reflect that diversity and introduce intervention with them as collaborators, rather than on them as subjects of that intervention.

As a team, COPNI remains concerned about the resourcing of the Bill. From our experience with professionals, the phased implementation of the Mental Capacity Act 2005 has presented real challenges. We do not want to see that experience repeated here. Although we understand the Department's rationale for introducing the Bill, progressing it through the Assembly and then finding the budget, we would really like adults at risk to experience the positive impact of the Bill as soon as possible.

I will put into context why the legislation matters and is vital. In our research, my team has carried out extensive reviews of offending against older people in areas such as crime, neglect and abuse. The evidence, supported by PSNI statistics, shows that the rate of physical and sexual abuse of older people is increasing, whereas the rates of crimes such as theft and burglary are, luckily, in decline. The evidence also demonstrates a growing awareness of the dynamics of abuse, of neglect and of crime against older people, whereby their vulnerability, dependency and diminished resources are preyed on and the behind-closed-doors nature of the offending is taken advantage of.

The legislation offers a real opportunity for us all to be partners in the safeguarding and protection of older adults against abuse. I thank the officials for the extensive and ongoing work that has been required to get the Bill to this stage. Aimee and I are ready for your questions.

The Chairperson (Mr McGuigan): Thank you. That was useful, as was the information that you sent us.

You said that you expect to deliver a more detailed paper in December.

Ms Casey: Yes.

The Chairperson (Mr McGuigan): OK. Will suggested amendments to the Bill be included in that?

Ms Aimee Miller (Commissioner for Older People for Northern Ireland): When giving a reflection on a Bill, we try to give, in some cases, recommendations, and, in others, food for thought — something that the drafters may want to give further consideration to or, of course, something that they may already have considered and disregarded. It will not be a redrafted version of the Bill; rather, it will look at the Bill from our perspective and see where it interacts with the needs of older people.

The Chairperson (Mr McGuigan): OK. Thank you. You mentioned the fact that the Bill should include self-neglect and self-harm in the definition of abuse, and you gave details of figures from Scotland —.

Ms Casey: Twenty-six per cent of cases.

The Chairperson (Mr McGuigan): Do we know what the equivalent figures are in the North?

Ms Casey: Not at the minute.

The Chairperson (Mr McGuigan): OK, but it is an important aspect that should be included.

Ms Casey: Yes. It was revelatory to hear that the Scottish experts had found that. They are a bit further down the road than us.

The Chairperson (Mr McGuigan): OK. How do you envisage the independent advocacy working?

Ms Casey: It has to be independent in order to help older people access the support and understanding that they need. A lot of times, people are trapped in their homes and in family and domestic situations, and it is hard for them to negotiate their way through the trauma that they are experiencing. Having an independent advocate to give their perspective and ensure that their wishes and needs are reflected is really important. We talk in our paper about "illusory" consent. I know what my mum was like when she went to the doctor: it was a case of, "Whatever the doctor says is fine", and sometimes I would have to say, "Mummy, we need this" or, "We need to do that". That is not being reflected. It is important that older people have an independent voice to speak for them when they are not able to represent themselves.

Ms Miller: We have to remember that anybody who falls into the category defined by the Bill will probably be at the most vulnerable point in their life. They will be incredibly vulnerable. The legislation applies to anybody who is over 18, but we are particularly interested in the older category — those who are over 60 and in COPNI's constituency. Imagine the support that a 30-year-old might need when they are vulnerable, and compare that with the support that an 85-year-old might need, irrespective of the vulnerabilities associated with the risk in the situation that they find themselves in. They should be able to have someone to support them in respect of what are really intrusive powers and to help them understand the system. Under the principles of the Bill, there is a desire and a requirement to ascertain their:

The only way to do that is to support the individual through independent advocacy. We also have to remember that the individual's entire support system could be the problem that brings them to the point of being at risk. It could be their family. They need to have someone who is independent of everything by their side to support them through that process. That is essential.

The Chairperson (Mr McGuigan): The adult protection board will be important. Do you think that your office should be one of the organisations that formally sits on the board?

Ms Casey: It would probably be best for us to be outside it at this stage.

The Chairperson (Mr McGuigan): Fair enough. That is all from me. I will move around the Committee.

Mrs Dillon: Thank you for the presentation, Siobhan and Aimee. I will go back to Philip's point on amendments. What might those look like? Has the Department outlined to you why it is reticent about including self-directed harm and self-neglect in the definition? Does it have reasons for not wanting to include those?

Ms Casey: I do not think that we have had the conversation about that. As I said, that is a revelation that came through in the evidence from Scotland, where they are a bit further ahead. I am not sure that the Department has deliberately not included it, but we wanted to highlight it as something pertinent that came up recently.

Mrs Dillon: Hopefully, officials will pick that up from this meeting. We can certainly raise it with them. It is important that we do, given the fact that there is that level of incidence — 26% of cases.

Ms Miller: The distinction between the Northern Ireland Bill and the Scottish legislation, which we used as an example, is that the Northern Ireland Bill requires "the conduct of another person". That takes it outside the category of self-directed harm. The important point about that is that it leads the reader to a certain idea of what that being at risk looks like, as you imagine an individual and the conduct of another person. It closes down other categories of harm. A more open-ended definition, as per the Scottish system, that does not require "the conduct of another person" might take a more inclusive look at what a person at risk's lifestyle is like and the various elements of what might bring them to the point of being at risk. It may be remiss to narrow the definition and reduce the scope.

Mrs Dillon: I agree about advocacy, because older people tend to look at authority figures and think, "I have to comply. It's what I've always done". We all probably get a bit more like that as we get older. How do we protect them when it comes to who that advocate is? Do you have any suggestions around that? In some cases, the very person who advocates for the older person is the greatest danger to them.

Ms Casey: The emphasis is on "independent".

Mrs Dillon: It is that they are an independent advocate. OK. That would have to be very clear. It cannot be an advocate of their choice, because the individual may just comply with the person who says, "I'll be your advocate". That is useful to know.

Older people are fearful. You outlined how there can be compliance: they do not want to be in trouble or to have any annoyance at their door. Can we put anything specific in clause 5 to ensure that warrants are only used as a last resort? How do we get the balance right? Yes, a warrant should be a last resort, but we should never leave it so late that we are too late to protect an older person. It needs to have value.

Ms Casey: It is about the intrusiveness of the intervention and understanding its implications and impact.

Ms Miller: It is about necessity and proportionality: that needs to be the backbone of everything that is done. The Bill is not designed to remove all the other safeguards that exist in the system; I imagine that the Bill is for the higher-end safeguarding issues. There should be other nets to catch things along the way before we reach the crisis point of using the powers that are outlined in the Bill.

Mrs Dillon: Is there something that needs to be in the Bill as regards guidance or training? You will be sending in a further report. It would be useful to know that to make sure that the Bill gets the balance right. We certainly do not want to leave it —.

Ms Casey: We would like to stress another point about independent advocacy: it is slightly ambiguous in the Bill. The Bill says that we should "have regard to" independent advocacy as opposed to it being mandatory. We advocate for mandatory independent advocacy.

The Chairperson (Mr McGuigan): It should be tightened up.

Mrs Dillon: That is brilliant. Thank you very much.

Mr Donnelly: Thank you for your presentations. There is a lot to go through, because it is a very serious Bill. The Bill exists because of your office and the work done by the previous commissioner as regards the Dunmurry Manor scandal. It is important that the Committee is tight on it all. I agree with Aimee, because I have experience, as a nurse, of looking after older people. They are incredibly vulnerable at that period of their lives. We have to put every check and every protection into the Bill. You have suggested quite a lot of changes and things that need to be strengthened. Are you concerned that, without those changes, the Bill could be a missed opportunity?

Ms Casey: It certainly will be a missed opportunity if we do not strengthen the Bill when we have considered the review and had the consultation. It would be a missed opportunity not to include amendments to strengthen the Bill and make sure that strong protections are in place.

Mr Donnelly: If the Bill and its terminology are not strengthened, through the amendments that you have suggested, will it adequately achieve what was envisaged by your office following the Dunmurry Manor scandal?

Ms Miller: Any developments in adult protection will be welcomed. We are sitting at a crossroads. We have a great Bill that we do not intend to criticise; we are suggesting some fine-tuning. Anything is better than the position that we are in at the moment, but we have the opportunity to drill down further, particularly on mandatory advocacy. If we, as an organisation, were to pin down the most important thing that we have highlighted in our advice, it would be mandatory advocacy. We really need to look at that, because, in the absence of legislative direction on mandatory advocacy and with the "have to regard to" terminology, it will become optional. Unfortunately, "have regard to" often becomes, "Have we got the resources?" as opposed to, "Is it a need?". It makes advocacy optional, which is a problem. On accountability, we have pointed out that we do not understand what will happen, under the Bill, if the bodies that have a duty to report and cooperate do not do so. We do not understand what the consequences of that will be. As we also mentioned, there is the notion of self-directed harm. We would be disappointed if those three things were not developed.

Mr Donnelly: How has your engagement with the Department of Health gone so far? Do you feel that you have had enough engagement with the Department?

Ms Casey: We have had a very strong relationship with the Department of Health, and it has been very complimentary about our team's input. The Bill has complete commitment from all sides. There is a shared purpose to get it over the line.

Mr Donnelly: What do you feel needs to be in clause 22, which is about guidance, for the legislation to be successful?

Ms Casey: I will pass that to Aimee, because she wrote the report.

Ms Miller: Let me remind myself about the specifics of clause 22.

Mr Donnelly: Do you want to come back on that question?

Ms Miller: The guidance needs to be clear and concise. We are looking at the Bill in the absence of guidance. Even on other aspects, such as CCTV, the provisions defer heavily to guidance. Any guidance has to be clear and transparent. It needs to be to the benefit of not just the person who will be subject to those orders but the front-line staff who will be trying to implement and manage them. If the guidance is not clear, they will be working in an ambiguous environment, which will add stress for them in what they are trying to achieve. We want consistency across the trusts; we want everyone to be on the same page. The guidance needs to be incredibly clear and transparent.

Ms Casey: It is about positioning the guidance and the training for staff as an opportunity to support staff as well as older people and other adults. The guidance has to be really clear. That has come across in your discussions last week with the Belfast Health and Social Care Trust and the Royal College of Nursing (RCN) about what they need, and in other discussions that you have had. We have to get it right at the front end. It would also be less costly. There is economic value in getting the guidance right at the start; that is really important.

Mr Donnelly: OK. Thank you.

Miss McAllister: Thank you very much for coming along today. I remember meeting Eddie Lynch as he commissioned the report on Dunmurry Manor. It is an example of where, as a result of a scandal, introducing a law to protect people has moved quicker. I know that 2018 to 2025 does not seem that fast, but, considering how slow we are at doing other things in Northern Ireland — look, for example, at how long the Muckamore and hyponatraemia inquiries took — it is welcome to see the Bill now.

Self-directed harm in over-18s is not included in the Bill. You said that, in Scotland, the figure for that is 26%. Does self-directed harm in under-18s have to be reported for those who are vulnerable because they are looked after by the state or they have a learning disability? Is that something that we see here from families whose loved ones live in secure care?

Ms Miller: We are not in a position to speak about under-18s; we are focused on the over-60s. However, I imagine that it absolutely does have to be, particularly in the circumstances that you describe, because they are under the supervision of the social services system.

Miss McAllister: I ask because, if it does, there could be learning as to why it is included. The Department would not have to set a brand new policy; trusts would be obligated to do it already.

Ms Miller: There is learning on that to be taken from Scotland. We talked about the 26% figure: it is the highest instance. Physical harm, at 22%, is the second highest. In Scotland, which is a comparable jurisdiction, self-directed harm has the highest instance of use of the protection..

Miss McAllister: Yes. It would be worth — hopefully the Department, rather than the Committee — scoping that out.

Who do you think could be an independent advocate? The trade union that represents social workers has been in front of the Committee, and I have met it privately a number of times. We have issues of social work vacancies and as regards what is required in social work. Adult social workers are often under pressure and are often in A&E departments. Could a social worker be an independent advocate, or is there an opportunity for someone else to fulfil that role, so that we are not just sharing the problem rather than solving it?

Ms Miller: In this situation, it would not be about whether the person is a social worker. It would not be a social worker dealing with the person in the system. That would not be another requirement of the health and social care system as it exists; it would be separate. The whole point of the independent aspect of the advocacy is that that advocate would not have any input into the person's care at that given time. It could be a social worker, but they would not be employed by the trust.

Miss McAllister: I support the idea and think that it would be very helpful. However, it could be a social worker, and there are still vacancies in social work, in not just trusts but the independent sector.

We know that some will move from trusts to the independent sector, so it will still create a flow problem. Can it be a multiskilled role and options, kind of like what Ray Jones said about children's care and children's homes, for example?

Ms Casey: I got the impression from the lady who was talking about the resource and the costing that that would come from within the teams and that people in different professions could be independent advocates if they are trained up. It is all about the training.

Ms Miller: Even in our office, we have a team of independent advocates. I am an advocate, and I am not a social worker, so there could be a wide range of suitable individuals who could go forward. It could be a situation where individuals are specifically trained and do not have to have any specific qualification in the background. That has to be ironed out by the powers that be, I imagine.

Miss McAllister: It is really helpful to know that it is not nailed to one specific profession.

I want to talk about serious case reviews. We have not really touched on that yet in the Committee. You talked a little bit about serious case reviews and when the need for them comes into play. I am sure that it will be hard to describe, but in what instance do you think that a serious case review will be needed? What are the criteria? We often have people in front of us to talk about serious adverse incidents, so it is about trying not to create another similar system that has major problems but, rather, creating serious case reviews that work. How do you envisage that it would work well?

Ms Miller: First, we really welcome the fact that serious case reviews were put on to a statutory footing, and we are glad to see that they "must" happen as opposed to "may" happen. Of course, we note that the Bill is entirely silent on what it will look like, such as what will trigger it, whether it will be published and whether there will be any follow-up monitoring recommendation. That all has to be clarified. The Human Rights Commission made some recommendations in that regard about the procedural standards, and we entirely endorse its position on that. I suspect that what will trigger it is in the name: serious cases where there is an opportunity for learning from where the system has gone wrong. I cannot imagine that it could be too much different from the serious adverse incidents that you described. That system is under review. It is perhaps for the legislative drafters to look at that to see how those two systems will run in tandem. It is really important for them to consider how they will interact and when one will be triggered as opposed to the other.

Miss McAllister: The reason I ask is that we often discuss how serious adverse incidents are not getting closure or answers. If we are creating something new, how do we make it work? You talked about the criteria, how they are triggered and whether they are published, but where is the best place to stipulate that? Is it in the Bill or in regulations or guidance? How do we do that?

Ms Casey: It needs to be stipulated in the Bill so that the guidance can underpin that. That came out when the Human Rights Commission was at the Committee a couple of weeks ago and talked about CCTV. Things need to be specified in the Bill, and then the guidance will follow so that there is no misinterpretation across different bodies or trusts.

Miss McAllister: Thank you. This is my last question, which is about CCTV.

Ms Casey: I know; we were waiting for it.

Miss McAllister: I understand the difficulties that people have with it, but, when you speak to people, they ask, "Is there CCTV?", and that is because of high-profile cases. Can you tell us a little bit about where you stand on CCTV, and, if you support its use, how you think that it could possibly work?

Ms Casey: It is about consent, dignity and proportionality. If you go around this room, you will have various and varied opinions on whether it is right or wrong. Then you have the whole question of how it is enacted and who has access to it. You talked about GDPR previously. Would we all like to be sitting in a care home talking to our loved ones knowing that our conversation is being either recorded or watched? Who would have access to those types of things?

Consent must be meaningful. We have to make sure that it is in there, that it is proportionate, and that the guidelines for how it is enacted and managed are clear. It needs to be targeted and proportionate, and there needs to be a really good reason for using it. I think that you will find that some people will want it, and others will not, but it is quite important to have the option to have it included in the Bill. We listened to the evidence session with the Human Rights Commission a couple of weeks ago about all the guidance and understanding that the PSNI has and its implementation. The learnings from those who know about it in other areas will be key in its implementation.

Ms Miller: The Department of Health acknowledges that a care home is, first and foremost, someone's home. Everything else has to stem from that principle. When we think of those facilities, which are where CCTV would most typically be placed, we have to think of that from the position of it being the individual's home. We cannot take a paternalistic view and say that we know what is best for a category of people just because they have reached a certain age. We have to look at them not as one group but as individuals within a group: some will have capacity, and some will not; some will want CCTV, because they prioritise the safety and reassurance that will come with that, while others will prioritise their dignity and would find it quite distressing to have CCTV. It is important that we have a piece of legislation that is reflective of diverse views. It has to be able to meet the needs, views and wishes of all in our society. I do not think that we can sit here and assume that we know what a group of older people would want in the scenario in which they find themselves. We have heard of some terrible situations, such as Muckamore, in which CCTV provided an absolute lifeline when it came to prosecutions. However, we cannot take the individual out of the scenario, and we cannot appreciate what one person would want.

COPNI is very concerned that some organisations will be pro CCTV, that they will want it and say, "Well, I have nothing to hide, so put the CCTV in", but that others will not want it. The situation with supply and demand — the availability of placements — in Northern Ireland is very challenging as it is. We would hate to see there being one facility that says, "We are a CCTV facility, so, if you want to come here, you have to consent to that", and another that says, "We are not a CCTV facility, so, if you want CCTV, you cannot come here". It is an important and nuanced point: there should not be a situation in which CCTV can be used as something to put barriers in front of opportunities for appropriate placements for individuals in Northern Ireland.

Ms Casey: Not to go down another rabbit hole, but CCTV is not the only way of protecting people in situ. A lot of abuse happens outside care settings, and you cannot have CCTV in people's homes. Technology enabled care — the use of sensors, monitoring and other technology in people's homes — is being tested. It was piloted in Coleraine through work that we did with Age NI last year. There are a lot of things that can be done to ensure safety in care settings, with monitoring that is not necessarily all down to CCTV. That is a whole other discussion.

Miss McAllister: Thank you very much. That has been helpful. As someone who has been vocal in their support for having CCTV in some way, I would say that it is important for me and all of us to remember that it is a complex matter. Thank you.

Ms Casey: The question is this: would we like it ourselves? It is about getting the balance right.

Miss McAllister: Thank you very much. I am sure that we will have more questions in December.

Mrs Dodds: Thank you for your presentation. Like Nuala, I found your response on CCTV helpful. It is probably one of the more vexatious issues in the Bill, and working it out so that it provides protection but not intrusion will be important. I have not seen a pathway for that yet, but that will be very important. If your loved one has been in a care setting and has had a dreadful experience in that setting, I can understand why you might say, "I want this. I want this", but everyone is an individual, and everyone is entitled to their privacy and dignity. We must be very careful that whatever is in the Bill respects that, and so on. That is helpful. Sometimes, we are drawn back from where, we think, we might have gone, so thank you for that. That is important.

I will ask a general question on an issue that has arisen as a constituency case. It is important to get a view. There is a lot in the Bill about the responsibilities, and so on, of people who are protecting people, and all of that, but one of the things that families find it difficult to get is accurate information from trusts and authorities when a complaint has been made. Do you have a comment on that?

Ms Casey: Do you mean a comment on what is happening?

Mrs Dodds: Why do trusts not comply with access information requests in a timely manner? There is a duty on care homes, and there is a duty on families: where is the duty on trusts to make sure that they are responding to safeguarding issues?

Ms Miller: The question is around when the complaint has already been submitted to the trust, and the release of information that comes back.

Mrs Dodds: Yes, access information requests.

Ms Miller: There are data protection issues and other complicating factors, which, I am sure, put pressure on the trust. We also have a system now that encourages complaints, so I imagine — to play devil's advocate — that the trusts are entirely bombarded. However, the problem behind all of that is poor communication; it is compounded by poor communication. That is maybe the point that you are making: that families —.

Mrs Dodds: It is, but I also think that there should be some compelling reason why trusts can simply ignore access information requests, etc.

Ms Miller: They cannot.

Mrs Dodds: I know that they cannot, but they do.

Ms Miller: In those situations, a complaint should be made to the Information Commissioner's Office. Some organisations, including ours, have advocacy teams. If constituents are finding difficulty in managing the complaints process, we are willing and able to assist, and we will help them to navigate that process. We will prompt the trust and break down the communication barriers. The Patient and Client Council (PCC) also offers support. If such things are happening, it is about seeking additional support to free up the system.

Another point to make is that the Public Services Ombudsman will take complaints directly without a response. If a response to a complaint is not received and not forthcoming, the complainant can go straight to the ombudsman, but we would be happy to support them through the next stages that they can take. The Information Commissioner's Office has obligations around official freedom of information requests and subject access requests. I imagine that it is sometimes a bit tricky, because the person who is making the request might not be the person whose data it belongs to. That may be a complicating factor. In general terms, I hope that that answers some of your question.

Mrs Dodds: It has given me some pointers. Thank you.

Ms Miller: I am happy to speak to you about that separately, if that would help.

Mrs Dodds: The interesting thing about constituency work is that all kinds of things happen in a week.

Ms Casey: Yes.

Ms Miller: Sometimes we get queries from constituencies, so, if there is ever anything that we can help with, we will be happy to do so.

Ms Flynn: Thank you very much for your presentation and for all the answers that you have provided so far.

I want to go back to the issue of self-inflicted harm and some of the potential gaps in the legislation. You might not have had the chance to look over the NISRA statistics that were released today and that show the number of suicides that there were in 2024. They show that there has been a 30% increase. There were 221 deaths in 2023, and the number of deaths recorded for 2024 is 290. It is important to say that there may be some specific reasons for that increase. Deaths that occurred in previous years may just have been picked up by the coroners office, due to that office's workload, and recorded in 2024. It is important to state that.

One of the glaring issues and worries for me in those statistics is the rise in deaths in over-60s. In 2024, one in five of deaths by suicide were of people over 60. The Chief Medical Officer (CMO) has released a letter on that this morning in which he says that there is a clear need for further support and research into trying to work out why we are seeing that rise. Obviously, it is all interlinked with the conversations that we are having today on safeguarding and on the particular points that you have raised around self-inflicted harm. Some feedback from you and your thoughts on that would be much appreciated.

Ms Miller: First, I was not aware of those statistics. It is really interesting and really concerning to hear the statistics on over-60s. What you have said is relevant across the board. We do not want to narrow any of the application of the Bill. We want, when given this one opportunity, this Bill to get the broadest catchment possible, so there is no reason why we would not include that, particularly when we can look to other jurisdictions that have had their adult protection legislation up and running for 10 years and that part of it has been so prevalent. With that in mind and to make it as beneficial and as wide-reaching as possible, we absolutely hope that that is an aspect of our advice that will be taken on board.

Ms Flynn: Thank you for that. The statistics were released only this morning. Sorry; I did not mean to put you on the spot in any way. I am sure that you will go away and take a closer look at the NISRA report, and maybe your additional report that we will receive in December will factor that in. Thanks very much for all the work that you are doing.

Ms Casey: Órlaithí, it will be interesting to see what the gender breakdown is on that. I have done some work on that before. It also speaks to the issue of access to mental health services for people over 65. There is a drop-off, and there has not been as much support around that or development on that as would have been wanted from the mental health strategy. When you look at rates of suicide in Northern Ireland, you see that the gender split in the over-60s is quite significant. When I worked at Age NI, we did a whole programme around men's health called Good Vibrations. We looked at the levels of alcoholism and addiction in Northern Ireland compared with other areas. I think that it is wider discussion that really will reflect on adult protection in the longer term. It is a wider discussion on mental health support for people over 60.

Ms Flynn: Absolutely. I would really appreciate it if, following today's meeting, we could continue this conversation offline and have another chat about it. Thanks very much.

Mr Robinson: Thanks, Siobhan and Aimee. You have been very helpful on clause 26, which is on the role of independent advocates. You have expanded on that for Committee members. I am keen to know your further thoughts about who, you believe, would be responsible for the training of those independent advocates and the monitoring of that.

Ms Miller: Where the funding is going to come from would have to be looked at. Organisations can be independent despite being funded by a certain Department. The association with a Department or its having the responsibility of a Department will not necessarily impact on its independence. I think that it is a joint project between the Department of Health and the Department of Justice, but I could be wrong about that.

Ms Casey: It is about all the bodies that we are talking about here: the PSNI, the Public Health Agency and all the bodies that are involved. It is not just about the health and social care trusts and what is happening in the community. Whether the independent advocate sits in the Department or externally, regardless of who does the training, what matters is what is in the training and that it is consistent across all those things. That is really important. It depends: as I said, the abuse happens everywhere, so different bodies will need to respond to that and appoint independent advocates. It is not clear yet.

Mr Robinson: You mentioned funding, which leads me to another question. I have expressed my frustration and fear that the Bill may not get the justice that it absolutely deserves. That fear is that we will not see the annual funding that it requires and necessitates. Given that the 'Home Truths' report dates back to June 2018 — back to the Eddie Lynch days — how frustrated have you been, Siobhan, at the pace of change from where we were then to where we are now?

Ms Casey: I am seven months in the job. My experience, from talking to the team and from what has been going on, is that there are good relationships. I have met the Department of Health as well. There has been communication. My experience is that people are working well together, and we are all delighted to see the Bill move forward. I have not really experienced how frustrating it has been to get to this stage. Have you, Aimee?

Ms Miller: 'Home Truths' did not identify a gap in safeguarding and then just stop until we got here. There have been massive changes in the system, which are culminating in the introduction of the Bill. We have seen real changes in awareness. People are more aware of what safeguarding looks like, of what people who are at risk look like and of RQIA inspections. Work on visibility and awareness of abuse is still happening in the background. Would we have wanted the Bill to be introduced more quickly? Of course. We would like it finalised now, up and running, fully funded and fully implemented, but other aspects of the system have been making progress in spite of the lack of legislation.

Ms Casey: The safeguarding conference that we were at in the Southern Trust and the extent of the work that is being done shows that safeguarding is endemic across all organisations. A lot of work is being done. A lot of people are very committed to it and are moving it along. It is not just about the legislation but about the whole infrastructure behind it. I have been impressed by the teams in the trusts, the work that they have been doing and the interactions that we have had with them. It is such a big area, however, and it is such a serious issue. It is growing. Just look at the stats: the number of safeguarding referrals over the past five years has grown from 4,800 to 8,600. Is that because there are more issues or because there is more awareness? We are not sure why that is; that is where we need clarity. The number of cases is growing. It is a big industry.

Mr Robinson: That is very helpful. Thank you.

The Chairperson (Mr McGuigan): Linda, you wanted to come back in with a quick point.

Mrs Dillon: It is just a quick point, and you touched on it, Siobhan, when you talked about the infrastructure and the importance of all that goes on behind the legislation. There is a separate conversation to have around the duty of candour. That touches on the CCTV stuff as well. Would a duty of candour make a real difference? People knew about the abuse that was going on, whether it was of elderly people or at Muckamore. People knew things. Would a statutory duty of candour be helpful in that infrastructure?

Ms Miller: Absolutely; it definitely would. A duty of candour could only help. It is all about the culture. The Department of Health is doing a lot of work with RQIA on the joint Being Human framework. It strikes me that loads of parts of the puzzle that are coming together are in the same vein, which is to be more open and transparent and to encourage openness so that individuals are not afraid.

We have not really touched today on the point about openness and people not being afraid. We have spoken to some of the organisations and individuals who will be responsible for the duty to report and cooperate. They are afraid, because they do not know what will be expected of them or whether they will get into trouble if they do not understand or do it right. How we roll that out and get buy-in will be as important as getting the wording in the Bill right. People need to buy into the Bill and see that it is an opportunity to safeguard the most vulnerable and set the culture of what we, as a society, will accept and what we will criminalise if the legislation is not adhered to.

If people are afraid and think that this is another requirement on them in a pressured system or another stick to beat them with, they will not see what we are trying to achieve through the Bill, which is a shift in responsibility from the vulnerable individual at the centre to the system. We want to take the pressure of being responsible for one's own protection off people. It is about saying, "Let us take the pressure off you. Let the system catch you and protect you". That all feeds into where we want to be as a system and the culture that we want to have across the board in Health and Social Care. We want people to be open, and we want there to be a duty of candour. However, we want people to feel that it is safe for them to have that duty of candour. Therefore, it all plays together.

Ms Casey: We want people to see it as an opportunity to do things better together.

Mrs Dillon: Absolutely. Thank you.

The Chairperson (Mr McGuigan): Siobhan and Aimee, thank you very much. Your comments have been very useful. The information that you gave us will, hopefully, be put to good use. Thank you very much.