More residents are living better lives in their communities, outside of congregated settings but further improvements required.

Today, the Health Information and Quality Authority (HIQA) has published a 10 year overview report on the regulation of residential disability services for over 9,000 people with disabilities.

The report sets out the impact of regulation over that time frame, detailing our findings and learnings in the key areas of governance and management, a human rights-based approach to care, restrictive practices, safeguarding and protection, and general welfare and development, as well as reflecting on current and future challenges for the sector.

It also highlights how regulation drove changes after findings of unsafe and institutional practices, insufficient staffing arrangements and unfit premises in 2013. 

HIQA’s Deputy Chief Inspector of Social Services, Finbarr Colfer, said: “Before 2013, there was no independent monitoring of the quality and safety of services for residents. While we found that most providers offered good quality care and support to residents, we also found a significant cohort of centres where there were very poor and concerning care practices, in some community settings but particularly in congregated settings. Residents should have been involved and consulted on their care, they should have felt safe in their homes and their rights should have been upheld – but this was not always the case in the early years of regulation.

“Since then, we have seen countless examples of residents’ lives transformed having moved from institutional settings, such as large campuses to living in a comfortable home in a town or rural setting. We have used our powers, including taking escalation action up to and including cancelling a centre’s registration where necessary, to protect residents and promote their rights, care and welfare.”

The report shows a reduction in the number of residents living in congregated settings. Many residents moved from large institutional-style residential settings into community-based settings which could better meet their needs. However, the pace of decongregation has stalled in recent years.

HIQA’s National Operations Manager, Ciara McShane, added: “Regulation has been a catalyst for change and for the better. Today, while things can still go wrong, regulation means that providers are challenged to address those issues quickly unlike in years prior to regulation where poor and unsafe practices could continue for decades. Most providers are now adopting a human-rights based approach whereby residents’ choices in their daily lives are respected. Now residents and their families can raise concerns directly with HIQA as the independent regulator to challenge providers – a role which we take seriously.

“Continued progress with decongregation for residents is slow, an acceleration of this, where residents move into community based settings would be welcomed. Our shared goal, should be that all people with disabilities can live active and fulfilling lives where their human rights are protected and promoted.”

ENDS

For further information, contact:

Marty Whelan 
Head of Communications and Stakeholder Engagement 
085 805 5202 
mwhelan@hiqa.ie 

Notes for the editor:

• HIQA was established on 15 May 2007, and commenced regulating centres for people with disabilities in 2013.
• From 2013 to 2023 the Chief Inspector within HIQA has: 
  • carried out over 9,400 inspections of services 
  • registered over 1,500 centres for over 9,000 people 
  • cancelled the registration of 15 designated centres where there were significant concerns
  • received 2,623 concerns about services, an average of 238 per year
• At the end of 2023, there were 1,574 centres offering 9,147 places for people with disabilities, an increase on 920 centres offering circa. 8,000 places in 2013.
• Between 2019 and 2023, there was a reduction of 658 placements of residents in congregated settings, as more residents live in community settings.
• The number of designated centres has grown from 920 in 2014 to 1,574 in 2023, attributed to three factors: responding to the emergency accommodation requirements of people with disabilities; the transition of people from congregated settings to smaller, community-based settings; and an increase in the number of individualised services for some people who find it difficult to share a living environment.
• There have been important milestones in the past decade which serve to strengthen the rights of residents. These include the National Standards for Adult Safeguarding, the Assisted Decision-Making (Capacity) Act 2015, publication of Guidance on a Human Rights-based Approach in Health and Social Care Services, and the ratification by Ireland of the United Nations Convention on the Rights of Persons with Disabilities.