Professor Mary McCarron:

Regarding over-prescribing, we are doing a lot of work with the school of pharmacy and pharmaceutical sciences. Dr. Myra O'Dwyer is leading out on that with Dr. Rosemary Gowran, the HSE national clinical programme lead. We are running a study there called EQUIP which is trying to develop a stop-start set of criteria in terms of prescribing. We are often seeing over-prescribing in some areas and under-prescribing in other areas. That is a concern. The prescribing patterns were very much driven by psychotropic drugs and laxatives. We were not seeing the same patterns of prescribing in terms of cardiovascular drugs, all of those medications. Even people who had conditions that one would expect to be painful were often not prescribed medications. This was also the case for some eye diseases. We are looking at this in great detail. Some medications are necessary. We have very high levels of epilepsy in this population, at more than 30% so we do need some of these medications. Our concern is particularly around the psychotropic medications, sedatives and tranquilisers. These certainly need to be looked at.

I want to address another point. In Ireland, we are very privileged to have specialist-trained intellectual disability nurses. These nurses should be in all our general hospitals and integrated care teams. They should be working in GP practices so that when a busy GP has a problem, there is a specialist-trained intellectual disability nurse there to navigate the issues and support the families and support the disabled individuals to have a better encounter. When we interviewed people with intellectual disabilities they told us that they could talk to their friends and family but that they were afraid to talk to medical or healthcare professionals. We could do this very quickly to address some of those issues if we are looking at solutions. We have a huge issue in identifying sepsis in this population, for example. The question is how we pick up on and identify some of these issues. They are some of the solutions to the concerns but we need to get these people into the integrated care teams. Dr. McMahon will address the issue of safeguarding.