ANALYSIS: Changing outdated practices will require courage and conviction at the highest level
MOST DEVELOPED countries have closed down large-scale institutions for people with disabilities, or are well on the way to doing so.
But in Ireland, more than 3,500 people still live in outdated facilities that are unable to provide acceptable levels of care.
Most residents have severe or profound intellectual disabilities and have been living in these settings for decades.
The model of service is highly medical – almost 40 per cent of staff are nurses – while many do not have access to basic therapies or activities.
Health authorities have long spoken of ending the practice of institutional care and moving towards a community-based model which would allow residents greater independence and choice. But for years, however, the Health Service Executive has handed over billions of euro to voluntary organisations and religious groups to run these facilities without meaningful oversight of the quality of care provide.
The response of the executive to the recommendations of a working group on “congregated settings” are hopeful signs of a change in this culture.
The report highlights major concerns over lack of privacy and dignity, with many changed and washed in communal areas.
Many staff try to provide acceptable levels of care and support in these environments, but it is an uphill task.
As the report notes, their best efforts cannot compensate for isolation from community, lack of individualised supports, poor quality environments or a deeply embedded culture of dependence.
Not only is the model of care unacceptable, but it’s also expensive.
The executive spends about €1.4 billion on disability services each year. Of this, some €470 million is invested in so-called congregated settings. The vast majority of this, 83 per cent, is spent on staffing costs.
Yesterday’s report shows that Irish support staff per head are much better paid than their UK counterparts, earning an average of €54,000 in Ireland compared to £18,000 in the UK.
The executive yesterday pledged to implement the findings of the report which call for all 72 institutions to be closed and replaced with supported or independent placements in the community.
But the process of closing down institutions will not simply be a case of replacing one set of buildings for another. Successful services will need to be carefully planned and supports – such as advocacy, person-centred planning, support for community inclusion, further education support – will be vital.
Will it be possible to do all this in seven years?
Time will tell. The pace of change in the psychiatric service, is hardly encouraging.
A decade ago then minister for health Micheál Martin announced a “complete programme” to transfer people with intellectual disabilities in psychiatric hospitals to appropriate accommodation by the end of 2006 at the latest. It still hasn’t happened.
The executive says it is committed to getting quality care for the services it underwrites, and insists the Croke Park deal will give it the flexibility to move staff where necessary.
The prospect of independent inspections by the Health Information and Quality Authority is also likely to highlight the need to keep promises to close these institutions.
But it will also take political will from the most senior levels in Government and across departments to ensure people with disabilities do not have to wait any longer than necessary for the kind of accommodation and support to which they are entitled.