Ms Tara Doheny:

The training was very important. When we set out with initial pilot projects back in 2018 and when we put out applications for funding, we very quickly realised that staff were not equipped to work with people and to help them move to community in a different way. They had been used to working and were trained to work in a specific way within the large institution. They did not have the time to work with people individually to see what their will and preference was. This was something that we found in the very early days so we consulted with the services and brought some of them together. They told us they needed training because they wanted to see people move on and wanted to work differently. Not everybody came on that journey in the early stages, so we engaged in social role valorisation training and over the years that developed training into the nine month training. That was a key ingredient to help staff understand and learn more about the people they were supporting, not only in a medical model. We were given some examples when out on visits where some people would have been on medication and then through the new discovery process, they had reviewed medication and that person no longer needed it.

Some of the most ingrained staff in institutions who are now the best champions for change went on that journey in the training. Not everybody stayed, some people felt this was not for them. We have to realise as well that within the large institutions there are cleaners, cooks and gardeners. Some of them came on the journey and did the training as well, so they were community connectors. That is what they were seen in terms of supporting people in the community. If they needed support medical support, they go to the local GP or the local nurse to get that support, but certainly the key ingredient was that training. I refer to the community of practice that came out of training and the learning from the other services of what was and was not working. Small things came up like how we work petty cash and transport when we move to community. All these small things were huge when they were moving from an institution out to community living. They were all issues that had to worked through and ironed out. The staff themselves worked that out. There might have been another service further along the tracks that was able to help and provide support.

For people who have now moved to the community, it is really important that that ongoing support, monitoring and review in terms of the discovery continues for the individual people. Everybody's needs change over time, so it is important that staff are trained to recognise that and to continue to review. The Deputy is right that there are more people in large institutions and training needs to continue, and the HSE national team is continuing that training through the service reform fund. That will be finishing up next year for the next cohort of people moving out of the large institutions.

Obviously there are some barriers around housing access, and suitable housing at the moment. That is a huge challenge. However, when we started this journey through the service reform fund we were fortunate there was accommodation available and the people were able to move in and we were able to use to the stories around the successes to support and to share with others.