30 June 2011

Parliamentary Questions

• Implementation of standards on a statutory footing
• Home help
• Use of medication

PARLIAMENTARY QUESTIONS

• Implementation of standards on a statutory footing

Deputy David Stanton (FG): asked the Minister for Health the progress that has been made in placing the National Quality Standards for Residential Services for People with Disabilities on a statutory footing;

Deputy Jonathan O’Brien (SF): asked the Minister for Health the action he will take to address the unacceptable conditions in residential care for many persons with intellectual disabilities;

Deputy Kathleen Lynch (Minister of State with responsibility for Disability and Mental Health):  I propose to take Questions Nos. 13 and 16 together.This Government is committed to ensuring that vulnerable people with disabilities in residential services are safeguarded and protected, and that their quality of life is enhanced. National Quality Standards: Residential Services for People with Disabilities were published by the Health Information and Quality Authority (HIQA) in 2009. The standards will provide a national framework for quality, safe services for people with disabilities in residential settings. The current Programme for Government includes a commitment to put these standards on a statutory footing and ensure that the services are inspected by HIQA. I am pleased to confirm, as I announced on 16th June last, that discussions have begun between the Department of Health and HIQA to progress this commitment. Compliance with the HIQA standards is already included in the Service Level Arrangements between the HSE and service providers in the disability sector. Service providers are required to have systems in place to assess quality and standards and to specify the actions being taken to maintain and monitor quality and service standards. Examples of such monitoring actions could include audit tools appropriate to the service, service user evaluations and satisfaction surveys, and carer and service evaluations. I understand that some service providers have also commenced a review of their services in the context of the HIQA standards. It is now generally accepted that large residential institutions are no longer appropriate for the provision of accommodation for people with disabilities. In this context, a report on ‘Congregated Settings’ was published on Tuesday 28th June 2011 by the HSE. ‘Congregated Settings’ are defined as living arrangements (whose primary purpose is the provision of services to people with intellectual, physical or sensory disabilities) where ten or more people share a single living unit or where the living arrangements are campus-based. The report recommends a move away from congregated/institutional type settings for the 4,000 people who resided in such settings in 2008, to community based settings over a seven year time frame. Since 2008 the numbers residing in such settings have been reduced to approximately 3,600 and there are plans in place to move a further 50 people to community based settings in 2011. The HSE has informed my Department that it will engage with the relevant stakeholders to ensure that an action plan to address the recommendations of the report is developed and implemented. The Department of Health is also engaging with the Department of the Environment, Community and Local Government in relation to the development of a housing strategy for people with disabilities, which will take account of the findings of the Congregated Settings report. 

• Home help

Deputy Michael Healy-Rae (I): asked the Minister for Health his views on the value of home help and the issue of the cutting of their hours and the detrimental effect that this is having on highly dependent persons who need to be cared for in the home, the ongoing campaign of CITCAAT whose campaign came about after a debate about difficulties that carers of persons with disabilities, be they physical, mental, emotional or intellectual, have in sourcing entitlements and services for the adults and children in their care; Deputy Kathleen Lynch (Minister of State with responsibility for Disability and Mental Health): I understand that the CITCAAT - Autism Support campaign raises a number of concerns in relation to the provision of services for children with disabilities, including children with autism. Under the Health Act 2004, the Health Service Executive is responsible for the provision of health and personal social services, including the provision of disability services for children and adults with intellectual disabilities. Specialist Disability services are provided to enable each individual with a disability to achieve his or her full potential and maximise independence, including living as independently as possible. Services are provided in a variety of community and residential settings in partnership with service users, their families and carers and a range of statutory, non-statutory, voluntary and community groups. The issue raised by the Deputy in relation to home help has been refered to the HSE for direct reply to you. Should the CITCAAT organisation wish to write to me on health related issues, I will arrange to have the matters examined. 

• Use of medication

Deputy Nicky McFadden (FG): asked the Minister for Health if he will give an assurance that medication is not being used to subdue patients exhibiting challenging behaviour at residential institutions;

Deputy Kathleen Lynch:  The use of medication in residential institutions operated by or on behalf of the HSE is governed by medication management policy and procedures that comply with legislative and regulatory requirements and best practice guidelines. It should not generally be used as a restraint or to subdue patients, or administered for reasons other than medical necessity and as prescribed by a medical practitioner legally authorised to do so. Under the Service Level Arrangements agreed by HSE with all disability service providers, governance arrangements require that care is service user centred and appropriate clinical governance and audit arrangements are in place. The HSE is committed to providing safe and quality care, and it has put in place a range of standards, guidelines and procedures to protect all service users, with a particular focus on children and vulnerable adults, from potential abuse or harm. The most recent development in ensuring best practice in this area is the Standards and Guidelines for Health Service Providers for the Prevention of Harm to Health Service Users: CARE SAFE, which recommends that restraint may be used as a therapeutic intervention in a variety of care settings, including older persons’ services, mental health services, disability services and children’s services. The Care Safe Standards and Guidelines were developed to address the risk of abuse or harm to all health service users but particularly for defined vulnerable persons while in receipt of health care services from HSE service providers. The standards and guidelines cover the following areas:·Protection of Service Users·Human Resources and Service providers Conduct·Consent·Providing Services, clinical interventions and treatments·Medication, Restraint and Managing Challenging Situations·Wills and associated financial management issues

Care Safe is currently being piloted in nominated areas in the country involving all of the care groups, including Disability. The outcome of this process will further inform full implementation. The requirement for the use of restraint can arise in a number of different circumstances and is only used in exceptional circumstances as an intervention of last resort. In this context, restraint can be defined as any physical, chemical or environmental intervention used specifically to restrict the freedom of movement of a person. It is a requirement that all managers within the health service ensure that service providers are aware of the Care Safe Standards and Guidelines. Managers within the HSE, and of all organisations which provide services on behalf of the HSE, are required to ensure that service providers (including all front line staff and support staff) have an appropriate written policy on the use of restraint in place in that setting, and that their agents are aware of the standards and guidelines outlined above.

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