A review carried out between 2007 and 2012 of HSE day services and personal support services for adults with disabilities, with an implementation plan for 2012 to 2016.
New Directions describes traditional day service provision
In 2008 New Directions recorded 81 organisations providing day services to over 25,000 people in 817 locations.
Over 90% of day services were provided by voluntary organisations, the remainder by the HSE.
All were funded by or through the HSE. Over 50% of all users had an intellectual disability, 29% mental health difficulties, 16% physical and sensory disability and 1% autism.
Service provision included day care for persons with high support needs, day activation incorporating active community inclusion, sheltered work(with discretionary payments or payment less than the minimum wage), open employment (with and without support), rehabilitative training, education programmes and voluntary work (as chosen by the individual).
There was 5600 staff working in day care services, mostly care support workers, supervisors and instructors.
Approximately 15% of staff fulfilled therapy, clinical and nursing roles.
Consultation found that day care and support services were diverse with no nationally agreed or clearly defined service model.
There was wide variability on structure and quality. Funding was varied and inconsistent. The review identified good experiences and worthwhile activities.
It also highlighted absence of choice, time spent doing nothing or doing repetitive activities of little use or value.
People with disability sought worthwhile activity, work and training, wanted to do ordinary things in ordinary places, to be part of the community, to be independent, make plans and make choices.
Service providers sought funding and staff to meet service demands and also quality standards and systems for monitoring services, to support providers to achieve common high standards.
New Directions for the Individual
New Directions recommends person-centeredness, community inclusion, active citizenship, and high quality service provision.
This means living and working in ordinary places, access to local services and facilities at ordinary times and community life and association.
The report identifies a menu of 12 individual supports that should be available to an adult with disability.
These include supports for:
- making choices and plans and making transitions and progression
- inclusion in one’s local community
- accessing education, training and work
- maximising independence
- health and wellbeing and personal and social development
- personal expression and creativity
- having meaningful social roles
- Influencing service policy and practice.
New Directions for the Service Provider
In New Directions a person centred day service is one that listens to and respects the person, has high expectations for the person and helps the person to manage risk and challenge. It also means providing ways for individuals and their families to influence policy, planning and review.
New Directions for the HSE
New Directions recommends that the HSE be responsible for promotion, evaluation and quality assurance of day services and personal support services.
New Directions is a policy document.
It recommends principles and a course of action for day service provision. There is no legal obligation on services to implement New Directions.
Day services remain unregulated and un-inspected.
“Simply thinking we are being person centred does not make us person centred.
The challenge is to move beyond the opportunity to engage in the development of our own person centred plan … to making sure the plan is properly implemented”
New Directions 2012