Dr. Austin O'Carroll:

Someone must be made responsible for it and this involves governance. When a report is produced, who will be responsible for ensuring it is acted upon? It is best to have one person or agency in that role, because diffusing such responsibility to different agencies may result in nobody following up on what has been learned. For example, I have not been given a brief in this regard but I intend to follow through to ensure that these recommendations are acted upon. It is crucial, therefore, to identify one person to ensure recommendations are enacted, or, if they are not, to determine why not and if better recommendations could be made. It can be learned from such a process that the right approach might not have been taken initially and that there could be a better way. Therefore, the key point here is having one person or agency charged with following through on recommendations and reporting on the progress made. This is where it is extremely useful to have a committee such as this one overseeing this area and ensuring that things are followed up.

Turning to the issue of staff, I agree with the point made. Staff turnover has dropped in recent years, however. There are two aspects to keeping staff happy. One facet obviously concerns pay and conditions. In the area of homelessness, though, another key concern involves the vision and the mission. Staff must feel a sense of purpose in what they are doing. Many agencies are beginning to recognise that it is important to ensure that staff know what the mission is and are part of making a significant difference to people’s lives. Another crucial aspect is imparting the skills to staff to enable them to maintain empathy. People who have negative interactions all the time lose empathy a little and it wears them down. However, if staff are given the skills we talked about, such as the trauma-informed care approach, they will then be able to convert negative interactions into positive interactions. Staff realising that they are having a positive impact in helping people is what keeps staff and maintains high staff morale. The important points, then, are the pay and conditions and ensuring that people have a sense of vision and mission and the skills to have positive relationships.

Moving onto the concept of experts by experience, this perspective is being developed in the United Kingdom. The initiative there involves identifying people who are then trained up to become experts by experience. Those trained people are then used to represent an organisation at all levels. Depaul is developing a peer programme and one already exists in St. James’s Hospital with the hepatitis C programme. It would be helpful to develop more of these peer programmes whereby we can get people who are homeless to input into the services. I have always felt that these programmes could be supported by the Department of Social Protection in respect of models that could be used to bring people into forms of employment. Peer programmes would be a great model in that regard. For example, we have people who were previously homeless involved in the hepatitis C programme going around and recruiting other people into hepatitis C treatment. The peers working in Depaul are going to be taking people to hospital for appointments and recruiting them into programmes to address their mental illness and drug addiction issues. I agree it is crucial that peers also be represented on these critical incident reviews, in addition to families and people who were involved with the deaths.