Presentation to the Joint Oireachtas Committee on Health and Children on Standards in Residential Services for People with an Intellectual Disability
On behalf of the Health Information and Quality Authority, I thank the Joint Oireachtas Committee on Health and Children for giving me the opportunity to discuss the Standards in Residential Services for People with an Intellectual Disability. I am joined here today by Marion Witton, Chief Inspector of our Social Services Inspectorate and Marty Whelan, Head of Communications and Stakeholder Engagement.
The Authority was established on 15th May 2007 as part of the Government’s Health Reform Programme. Reporting to the Minister for Health and Children, the role of the Authority is to promote safety and quality in the provision of health and social services for the benefit of the health and welfare of the public. Underpinning the work of the Authority is a key focus on driving patient safety and enabling continuous improvement in Ireland’s health and social care services. Our mandate extends across the quality and safety of the public, private (within its social care function) and voluntary sectors. The Authority has statutory responsibility for:
Setting Standards for Health and Social Services – Developing person-centred standards, that are based on evidence and international best practice, for health and social care services in Ireland (with the exception of mental health services).
Monitoring the Quality of Healthcare – Monitoring standards of quality and safety in our health services and implementing continuous quality assurance programmes to promote improvements in quality and safety standards in health. Undertaking investigations into suspected serious service failure in healthcare as appropriate.
Health Technology Assessment – Providing informed decision-making and ensuring the best outcome for the service-user by evaluating the clinical and economic effectiveness of drugs, equipment, diagnostic techniques and health promotion activities.
Health Information – Advising on the collection and sharing of information across the services and evaluating and publishing information about the delivery and performance of Ireland’s health and social care services.
Social Services Inspectorate – Inspecting and registering residential care facilities for children, older people and people with disabilities. Monitoring day and pre-school facilities, children’s special care units, children’s detention centres and foster care services.
The core values of the Authority are:
Putting people first – we will put the needs and the voices of service-users, and those who advocate on their behalf, at the centre of all our work.
Fair and objective – we will be fair and objective in our dealings with people and organisations, and undertake our work without fear or favour.
Open and accountable – we will share information about the nature and outcomes of our work, and accept full responsibility for our actions.
Excellence and innovation – we will strive for excellence in our work, and seek continuous improvement through self-evaluation and innovation.
Working together – we will engage with those who provide and use Ireland’s health and social care services in developing all aspects of our work.
We are very conscious of our responsibilities to Government and to the Oireachtas. It is my desire, and the clear determination of the Board of the Authority, that we engage openly and constructively with all stakeholders, including the Oireachtas, and I look forward to hearing your views on this and all aspects of our work.
The focus of today’s presentation is to update you on progress in relation to the development of the Draft National Quality Standards for Residential Services for People with Disabilities. This opportunity to engage with you is particularly welcome given the importance of the Authority’s standards development work in safeguarding vulnerable people and in driving quality and safety for people using such services. They mark a significant step for social care service provision in Ireland.
It is of credit to the Oireachtas that the importance of setting standards in the social care sector has been clearly recognised and provided for in legislation. For the first time, the Health Act 2007 establishes a statutory obligation for the inspection and registration of designated centres, including those that provide services to people with disabilities, whether provided by the Health Service Executive, voluntary, or private providers.
These Draft Standards take account, and seek to support the implementation, of relevant Irish legislation such as the Disability Act 2005, and anticipate expected changes to legislation on the issue of consent, under the Mental Capacity Bill 2008. The general underlying principle informing the Standards is that people with disabilities should be supported and safeguarded in living the lives of their choice, in as independent a way as possible, rather than being “cared for”.
Our overall aim in creating these Standards is to promote good, safe practice. We would expect them to further drive continuous quality improvement of residential services for people with disabilities in the coming years. The Draft National Quality Standards outline what is expected of a provider of services and what a service-user, their family, and the public can expect to receive in such residential care settings. I firmly believe they will contribute towards allowing people with disabilities to live in a safe, caring and respectful environment.
The Standards are grouped under seven headings all of which aim to cover the key components of a safe, respectful and high quality service for people with disabilities. These include: quality of life staffing protection development and health rights physical environment governance and management.
Taken together, they aim to set out what a good quality service for people with disabilities should be.
The Standards are intended to ensure that those who live in residential centres receive a safe and high-quality service. They define an agreed level of quality that must be maintained in all residential services and furthermore, enable the establishment of a culture of continuous improvement across all settings which provide social care. The Authority will also, with reference to our function on the independent assessment of need, continue to work with the Department of Health and Children to agree a method of monitoring the implementation of the Standards for the independent assessment of need for people with a disability, and will be reporting on the Health Service Executive’s work in relation to such assessments.
Due to the wide range of experiences of people with disabilities in residential services, the Standards place emphasis on enablement. For this reason, although the Standards are clear and specific, they are not overly prescriptive in order to best meet the tailored needs of an individual, thereby providing a robust framework that holds across the diversity of residential service settings. The Standards endeavour to ensure that people with disabilities are enabled to make choices, can participate in the running of the residential centres in which they live and can fully contribute to life in the wider community – if they choose to do so.
Importantly, the Standards safeguard the rights and interests of people with disabilities in residential centres, to enhance their quality of life and to support the development of person-centred care. By providing a benchmark against which service providers can measure the quality and safety of their services, the Standards also provide a guide for service-users and their families as to what they can expect of services.
A consultative approach is key to the Health Information and Quality Authority’s values of fairness and objectivity, openness and accountability, excellence and innovation, and working together. To maximise the input of all stakeholders in the development of these Standards, an extensive process of consultation was undertaken. As a result of this engagement, our Draft Standards have been developed with input from those who use residential services, their representatives and advocates, the providers of the services, the public and other stakeholders. By adopting an open and inclusive approach to consultation, the Authority has achieved the important support of key stakeholders including those who use residential services.
Throughout the development of the Standards, the work of the Authority was guided by the principles of:
Evidence-based best-practice – to ensure that the Standards are underpinned by the most up-to-date national and international evidence Person-centredness – to facilitate the meaningful inclusion of all stakeholders, including both service-users and providers of social care services, in the development of the Standards.
A focus on effective outcomes – to ensure that the implementation of the Standards will be measurable and result in tangible and lasting improvements in services.
A Standards Advisory Group was brought together by the Authority in late 2007 to further inform the development of the Draft Standards. This Group consisted of representatives from the statutory and non-statutory sectors, along with service-users and their families, and also included representation from the Department of Health and Children, Health Service Executive, National Disability Authority, Inclusion Ireland and others key contributors. The Group met on a regular basis to assist and inform the development of the Standards. Finally, following the development of the Draft Standards, they were published and a comprehensive public consultation was undertaken by the Authority which was tailored to the specific needs of the Standards development project.
To increase the accessibility of the Draft Standards document, three formats were produced: full text, Plain English (endorsed by the National Adult Literacy Agency) and an Easy-to-Read version (endorsed by Inclusion Ireland). Braille and audio versions were also available on request. The Draft Standards documents were circulated widely to over 1600 residential units nationwide, service provider representative organisations, advocacy groups, professional bodies and members of the public. All formats were also placed online on the Authority’s website. To facilitate the provision of feedback, a consultation feedback form was developed for use, along with a dedicated online feedback area.
In order to further maximise participation and inclusion, the general public consultation was supplemented with 12 focus groups with service-users, their families and frontline staff. In addition to this, 16 one-to-one interviews were conducted with people with disabilities for whom participation in group discussion was not feasible.
The feedback from consultation was very positive. The provision of alternative document formats, to facilitate engagement in the consultation process was widely welcomed, with the National Disability Authority in particular providing positive comments on the accessibility of the Standards for all audiences. Stakeholders reported that they found the Standards accessible and easy to read. There were no suggestions for the addition of supplementary standards as feedback suggested that the Draft Standards covered all key areas of importance.
The feedback from the public consultation will be considered by the Standards Advisory Group and will inform the Authority as it finalises the Standards. Once the Board of the Authority has approved the Standards, they will be sent to the Minister for Health and Children for her approval. Following their completion, regulations will be drafted by the Department of Health and Children to give statutory effect to the new standards. These will form the first registration of residential services for people with disabilities. All centres providing residential services will then be inspected and, if they meet the standards, will be registered to provide the service. This will apply to the Health Service Executive, private companies and voluntary organisations.
We intend to work closely with service providers and make sure they understand what will be expected of them in an inspection and registration process and, most importantly, monitor that they are able to make the changes required to improve their service. However, if there are serious concerns with a provider not meeting the standards, the Authority will have the power to withdraw the licence of a service provider.
We are fortunate to have received considerable buy-in in the development of the Standards and this is a positive step towards a culture of ongoing service improvement. We very much appreciate the contributions that have been made by many people to develop what need to be high, quality and meaningful standards. In advance of the formal inspection process, it is our desire that services will commence a process of review and development and particularly focus on the establishment of a culture of continuous quality improvement in the provision of social care services for all service-users.
Our overall aim is to promote best practice in residential services for people with disabilities, in keeping with our core focus on driving safety, which underpins all of our work. We are conscious that the safety and wellbeing of some of the most vulnerable people in our community depends on the ability of the Authority to set high standards and work in effective partnership with all involved in the delivery of health and social care – this is a responsibility that we do not take lightly.
On behalf of the Authority, I thank the Committee again for this opportunity, and am happy to take any questions that you may have.
Head of Communications and Stakeholder Engagement
01 8047651 / 086 2447623