James Reilly (Fine Gael) | Oireachtas source

I welcome the Minister of State. It is very appropriate that he is taking the Bill given his long interest in this issue. To be helpful to the previous speaker, HIQA inspecting the premises in question will not cause a delay. The delay will be caused in premises meeting the standards laid down. Some of them face serious challenges in correcting physical surroundings which are no longer acceptable. Some involve serious engineering issues, including in listed buildings. Nonetheless, like everybody else in the House, I would have loved to have seen the issue addressed sooner, but we all realise the financial crisis the country was in and that money was not available. It is now and it is being invested wisely and appropriately in services for those who are the most vulnerable in our society.It is important to re-emphasise that the Minister of State said HIQA will continue to inspect these buildings and ensure the care standards are met. This brings me to another point. Will the Minister of State confirm there will not be any fire safety or other safety issues that will imperil clients? As with Senator Swanick, I believe we want to move to integration, not segregation. Having worked for 20 years in St. Ita’s with individuals with intellectual disabilities, I remember the horrors of Leas Cross and the paradox of the fact that people were moved there from old institutions with paint peeling off the walls. This was before I was involved in politics, so I am not trying to score points here; it is just the reality. In the old institutions, the ethos and culture in respect of the patient or client was beyond reproach. Then they moved to the palatial surroundings of Leas Cross. In fairness to Deputy Fergus O’Dowd, he exposed what was happening there. The patients in Leas Cross had palatial surroundings but did not have care. To me, care comes first, and the ethos and culture that support that care are most important. Therefore, as we rightly plan for de-congregation and integration, we need to do so very carefully in regard to continuity of care, the knowledge carers have of patients and clients, and the relationship they have with them. The staff are acute observers of behaviour and know when a client is getting into trouble. They know the client's medical history and how he or she behaves. I experienced this and learned a considerable amount from the nursing staff at St. Ita's about individual patients.

I agree with Senator Swanick about the circumstances in which flare-ups in behaviour were addressed by sedation, sometimes by the doctor on call, but after which the higher dosage of medication was left in place, such that the next time there was a behavioural disturbance, an even higher dose was prescribed. One could see the dosage rising. Going in as the regular general practitioner, I was always asked by the nurses whether I would not address this issue and take the clients off the higher doses when their behaviour improved. My point is about the skill and care of the majority of staff who look after the very vulnerable and disabled. We will always have outliers like Áras Attracta, and HIQA is in place to protect people in this regard. The importance of HIQA cannot be overstated. It is very important that we protect the most vulnerable.

We had a debate yesterday in the Chamber on housing, with a particular focus on people with a disability. If a Minister for Health speaks to any person with a disability, that person will say she does not know what she is doing talking to a Minister responsible for health, as she is not sick. Rather, she will say she has a disability and ask for help and support with that disability. That is what we seek to do.

When I was Minister for Children and Youth Affairs, I was very pleased to be able to introduce a new scheme to support children with special needs in the preschool years. In health, education or any other area, the earlier the intervention, the better the outcome and the better the value for money. One gets much better bang for one’s buck and much better outcomes.

We need to ensure that only in the most severe and rare circumstances do people with a disability end up in care settings of a larger nature. We really should be seeking to support many people with a disability at home in modified housing. They have a considerable amount to add to society. Very often, they have hidden abilities. We only have to go back through history to note people who were considered to be odd and not the intellectual match of their peers but who, in their given area of interest, were far superior and made some of the great discoveries of science. At the ordinary level also, they have so much to add. Children who are raised with children with a disability learn so much and have their lives enriched so much by it. The same applies to us as adults.

I welcome the fact that the Minister has been up front about this. As every other Senator has acknowledged, this is a very common-sense response to a set of circumstances. At the core must be the best interest of the client with the disability. This is a complicated issue to address across so many different areas, as I have outlined. However, having said that, we look forward to HIQA's ensuring those who are more vulnerable with disabilities are protected when in the care of the State and that the various premises in which they reside, which are their homes in many cases, are safe and of a standard such that we would be happy to have our loved one therein.