People with disabilities in large institutions face 'significant differences' to those in smaller settings

Overall, data on 2024 showed 1,655 registered centres offering 9,246 residential places. File photo

Fewer people with disabilities live in large institutions now but they face “significant differences” in their quality of life compared to “happier” people in smaller settings, Hiqa has warned. 

Finbarr Colfer, chief inspector designate with Hiqa, and his colleagues appeared before the Oireachtas committee on disability matters to discuss its overview report on 2024. A key strategy published in 2011 advised closing large institutions and moving people with disabilities into smaller, community settings by 2018.

There has been a lot of frustration at the slow pace of the move since then. By December last year, Mr Colfer said Hiqa noted a “reduction of approximately 33%” with 1,941 people living in institutions. This compares with 2,914 in 2019.

He told Senator Margaret Murphy closure is not compulsory. “What we have found is there has been a significant difference between the compliance levels and the quality of life and the safety for residents in congregated settings than there were in community, residential services,” he said.

The move to smaller units has been “a good development”, he added. He said while “we have seen improvements” the difference in standards remains.

Ciara McShane, interim deputy chief inspector, said people in community units have “a much better quality of life” now.

In one example in the northwest, she said after the move: 

Those residents have chosen where they live, chosen who they live with, they are in more control of their daily routines than in the large setting. 

Inspectors report people get to know local shops, build friendships, start classes or work and other everyday activities where possible. “They’re happier,” she said. “And even their families would talk about their lives being magical or they’re now living a full life.” 

In contrast, larger settings were often structured around what worked for staff, she said. 

Hiqa now includes a leaflet for residents in all centres in their pre-visit pack. This has photographs and descriptions of inspectors, she said, so everyone knows who they are on the day. 

Overall, data on 2024 showed 1,655 registered centres offering 9,246 residential places. This is expected to grow, Mr Colfer said. Inspectors found 78% compliance with standards with some centres going beyond the minimum expected.

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Part of Hiqa’s work, he said, is to help centres meet standards including around management, governance and following a human-rights based approach. Residents have told inspectors of how the latter "increased their independence and the positive support they receive from staff in their centres”, he said.

However, Mr Colfer also pointed out there are “a small number of providers” which do not meet these standards. He told Independent TD Gillian Toole worries arose during the pandemic.

Most centres cut down on the numbers of staff going in and out which led to some providers having “significant issues” around understanding what was going on in some areas. Work has been done to examine this, he said, adding Hiqa is engaging with the government's covid-19 evaluation.