The Confidential Recipient for Vulnerable Persons has communicated her serious concern to the HSE CEO about the role’s “continued independence”, it has emerged through parliamentary questions (PQs).
It follows the recent transfer of the Confidential Recipient’s direct reporting line to the HSE Chief Social Worker. The change requires the Confidential Recipient to escalate matters to the Chief Social Worker when she (the Confidential Recipient) is dissatisfied with the HSE’s response to concerns she has received and examined.
The Chief Social Worker role was established to have overall responsibility for delivery of HSE adult safeguarding services. The Confidential Recipient is appointed by the HSE, but “independent” of the Executive. The new reporting line has prompted concern from the Confidential Recipient about an inherent conflict of interest.
It is the second time the HSE has controversially changed the reporting line of the Confidential Recipient – a role it created in response to the Áras Attracta scandal in 2014.
Responding to recent PQs from Deputy Peadar Tóibín, the HSE stated Confidential Recipient Ms Gráinne Cunningham O’Brien had “raised concerns” with Mr Bernard Gloster regarding the role’s continued independence. The HSE maintained that the Office of the Confidential Recipient “continues to be independent”.
The HSE also stated the delegation that established the Confidential Recipient was “no longer valid” as it was issued by a former HSE Director General to a previous Confidential Recipient.
The delegation states that the role of the Confidential Recipient is to “independently” assist and advise service users, families, other concerned individuals and/or staff members who may wish to report concerns and issues regarding the care and treatment of individuals in HSE or HSE-funded agencies.
The Confidential Recipient assists with the referral and examination of concerns, and must be satisfied that these are appropriately addressed by the HSE. The delegation also outlines that any dispute as to whether a function has been delegated to the Confidential Recipient will be decided by the Director General.
As of 2021, the Office had managed over 1,200 formal concerns and complaints, and hundreds of informal queries. These spanned areas including quality of care, safeguarding, lack of services/staff, inappropriate placements, and lack of communication by HSE services.
‘Very independent’
The late Ms Leigh Gath, a disability activist and Thalidomide survivor, was the first Confidential Recipient. She held the role until her retirement in 2022. Ms Gath had an escalation pathway directly to the HSE CEO if the response from local and regional HSE management was deemed unsatisfactory.
Speaking to the Medical Independent in 2022, Ms Gath said her Office was “very much independent”.
“The only person I answer to is [then CEO] Paul Reid. That is the only person that can, if he wants to, tell me what to do. And he never does tell me what to do.” Ms Gath also suggested the Confidential Recipient model should be replicated in each of the health regions.
Near the end of her tenure, however, the HSE signalled that the role would report to the National Clinical Director of Quality and Patient Safety. Ms Gath opposed this change in the interests of the Office’s independence. However, it was approved by the HSE board. The HSE stated that Ms Gath’s successor would “still have access” to the CEO if the need arose.
The HSE openly recognised the value of the Office whilst instigating this change. In September 2022 Ms Yvonne O’ Neill, the then National Director of Community Operations, presented a paper on the Office to the HSE board.
She outlined that the foremost themes in cases included staff behaviour, access to services, placements and eligibility. According to the paper, there were a range of learning points from these cases which could improve how disability and other services were funded, configured and provided to improve person-centeredness.
The paper stated that the data contained in the Confidential Recipient’s annual reports had been integrated into planning and performance management. However, at present, the Confidential Recipient annual reports are published in arrears by the HSE. The most recent is the 2023 publication, which was presented to the HSE performance committee by the Chief Clinical Officer and the Chief Social Worker in December 2025 and published in January 2026 (see panel below). Findings are no longer publicised to media through the HSE Press Office.
‘Highly valued’
The HSE established the Chief Social Worker position in 2024, with Ms Amanda Casey appointed to the role.
The Chief Social Worker has overall responsibility for delivery of adult safeguarding services. The role is responsible for leading delivery of a reform programme to support implementation of the Department of Health’s adult safeguarding policy framework for health and social care. As a senior member of the leadership team of the Chief Clinical Officer, the Chief Social Worker will direct and lead on reviews of serious safeguarding issues within HSE services.
In response to Deputy Tóibín’s PQs (which were directed to the Minister for Health) the HSE maintained it had “not made any moves to subsume” the Confidential Recipient into the internal structures of the HSE.
“The HSE has, in line with the establishment of new structures and governance, changed the reporting relationship for the Confidential Recipient. This is in line with the HSE’s wider reform programme for adult safeguarding. This change in reporting relationship should in no way impact on their independence or confidentiality and will not reduce the ability of service users and patients to report concerns confidentially to the OCR [Office of the Confidential Recipient] to receive support, advice and guidance.”
The Office of the Confidential Recipient “is highly valued and respected by the HSE Senior Leadership Team”.
Safeguarding framework
One of the PQs asked the Minister if she would strengthen the Confidential Recipient’s role in consideration of the Department’s policy framework for adult safeguarding.
The HSE stated its work to “strengthen” safeguarding included reviewing several existing structures and policies. “A review of the role and function of the Office of the Confidential Recipient will take place in 2026 as part of this process, as recommended in the ‘Moving Forward: Adult Safeguarding in the HSE’ report, and at the request of the HSE CEO”.
The HSE outlined that the framework represents a “significant expansion of the scope of adult safeguarding responsibility for the HSE and commits to a number of key legislative changes to underpin this work”.
These will include legal duties on health and social care service providers to put proactive safeguarding measures in place; increased powers for HSE safeguarding and protection teams; and introduction of mandatory reporting of concerns or allegations of abuse in specified circumstances.
The HSE will lead and coordinate adult safeguarding across the sector and will have statutory functions, duties and powers to underpin this role. The remit of HIQA will be extended to include independent oversight and monitoring of adult safeguarding services delivered by the HSE.
The Department has acknowledged that establishing an independent body would have addressed concerns about the HSE “investigating” issues in its own services. The Department provided several reasons for retaining safeguarding functions and structures within the HSE, including timelier implementation and system reform (compared with establishing a new statutory agency).
Some respondents to a public consultation on the Department’s draft proposals expressed support for safeguarding duties remaining within the HSE. However, others raised concerns about issues such as oversight, investigation processes, governance and organisational capacity of the HSE and called for the establishment of an independent body.
As one respondent stated: “The HSE has repeatedly demonstrated an inability to safeguard individuals in its care. The safeguarding authority of Ireland must be located outside of the HSE and totally independent of the HSE.”
PANEL
Insufficient PA hours raised in Confidential Recipient’s report
Personal assistant (PA) hours often commence when the PA leaves their work base, rather than arriving to the person’s home, according to concerns received by the Confidential Recipient in 2023.
In addition, the lack of PA access for people over 65 is restricting independent living, stated the Office’s 2023 annual report. “They are informed [by the HSE] that as they were not availing of the PA service prior to reaching sixty years of age, they are not entitled to the service. In this situation, service-users are informed they can apply for home support service in the home but not outside of their home.”
In total, the Office received 146 complaints/concerns, an increase from 109 in 2022. The issues related to areas including quality of care, alleged safeguarding failures, lack of services/staff, and access to equipment.
The concerns received were “not only complex” but illustrated “the seriousness of the raised concerns relating to patient safety and quality of care”.
In regard to home support services, the report referenced issues related to quality and safety of service provision, frequency of service, staff resources and turnover of staff. “Often, there are additional concerns intertwining with the home support service leading to complexities in resolving the reported concern. Service-users are also complimentary of the service and rely on the service to support their independent living.”
The report referenced complaints in respect of mental health services, noting concern among families that raising complaints will be perceived as “being difficult”.
The report highlighted the issue of inappropriate placements, including cases of people aged under 65 “being presented with the nursing home pathway as the only option” when they required residential support.
In regard to respite, an emerging theme was service-users being unable to access further respite, as the these beds were now being used for full-time residential placements.
“It comes as a shock and disappointment to them and their families. The [Confidential Recipient] recognises the need for fulltime residential placements but also recognises taking away a valuable respite service from service-users is not helpful to supporting service-users and their families.”
In 2023, the Office began to receive increased requests for advice, consultations and guidance from service-users, families, professionals and advocates. In these situations, service-users were self-advocating to resolve their complaint and leading out on the process at the local level.
“Professionals were also handling complaints at the local level and reaching out to this Office for advice and guidance to resolve concerns with HSE-funded services and strengthen and maintain effective partnership working with service-users, their families and support network.”
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