Improvement of lives through regulation of the disability sector

Through inspections and interactions with residents and service providers, Hiqa is assured regulation is improving the lives of people with disabilities living under State care, writes Mary Dunnion.

The Health Information and Quality Authority (Hiqa) yesterday published 31 reports on residential services for people with disabilities. So far this year, we have published more than 280 reports on this type of social care service.

While many of these inspections have found residents receive a good service and enjoy a good standard of life, a large number of reports show that a significant number of adults and children with a disability experience a quality of life well below that which would be expected in modern Ireland.

Hiqa commenced the regulation of the disability sector in 2013. Over the past three and a half years, we have carried out thousands of inspections and spoken with tens of thousands of residents, their relatives and staff.

Many of the residents we spoke with in 2016 were happy with their service and felt they were receiving good care. Nonetheless, a considerable number of people told us that they were not satisfied; that the services were not ensuring residents were at the centre of decisions affecting their lives; and that services were failing to meet their needs.

Designated centres for people with disabilities provide roughly 9,000 beds for vulnerable children and adults with a disability. There are more than 1,000 such centres across the country.

Disability service providers have a legal obligation to ensure that these services are safe for the people living there. Where providers fail to do so, like yesterday’s reports on centres operated by St Vincent’s Centre and Cork Association for Autism, Hiqa has powers to enforce compliance with regulations.

During 2016, 11 notices of proposal to refuse the application to register and cancel the current registration status of designated centres for people with disabilities were issued.

Throughout 2016, we required service providers to attend 153 meetings with the Office of the Chief Inspector to account for their failure to meet their responsibilities to safeguard and care for vulnerable people with disabilities.

There are a variety of reasons why certain designated centres for people with disabilities fail to achieve the required level of compliance to allow them to be registered. These include:

• Inadequate safeguarding measures;
• Poor governance arrangements;
• Institutionalised and outdated staff practices;
• Inappropriate placement of people;
• Poor physical infrastructure and living environments.

Some of these issues can be resolved by ensuring that the registered provider and managerial staff are competent, by reorganising and or enhancing current resources and by safely transitioning residents from congregated, institutional style settings.

Our inspectors have witnessed substantial improvements in the quality of people’s lives once good management and oversight arrangements have been put in place and when residents have moved into the community.

However, the recurring issues we see of poor governance, inadequate safeguarding measures and institutional staff practices are more difficult to overcome and require strong leadership and a commitment to changing the culture of an organisation.

Notwithstanding these challenges, there is much good work being done. We have seen a gradual improvement in services for people with disabilities over the past few years and most providers have a positive attitude to regulation.

Through our inspections and interactions with residents and service providers, we are assured that regulation is improving the lives of people with disabilities living under the care of the State.

To be effective, regulation must respond to people’s needs. It must also adapt to changing circumstances. Hiqa constantly seeks to improve regulatory practice to ensure that the needs of vulnerable people are being met.

We recently published a series of research papers exploring the future of regulating health and social care services. The paper on disability services looks at some emerging models of care which do not fall under the definition of a designated centre under the Health Act 2007, and are therefore unregulated, as highlighted in an editorial in the Irish Examiner on May 20 , 2017, ‘Community care plan causing great concern’. One example of this is where people are moved out of a congregated setting to services that have no regulatory oversight.

It is important to note that service users in these unregulated homes may be just as vulnerable as those being cared for in designated centres. They also have the same right to safe, high-quality care.

The Government needs to review Hiqa’s regulatory powers to ensure oversight and provide public assurance on what it’s like to live in these services.

All people deserve the right to choice, to safe care, to a suitable place to live, and to be treated with dignity and respect.

Hiqa will continue our work to guarantee this right to all people with a disability in receipt of care and to ensure that those services we already do regulate are providing this to the vulnerable adults and children in their care.

Mary Dunnion is Hiqa’s director of regulation and chief inspector of social services.