Teresa Costello (Fianna Fail) | Oireachtas source

I welcome the Minister of State. Day services for adults with disabilities provide a vital network of support for more than 25,000 people across this State, individuals whose personal circumstances, interests and aspirations are widely diverse. There are people with physical, sensory and learning disabilities. They range from young adults beginning their journey into adult life to older people of retirement age. They live in small communities in isolated rural areas and in towns and cities in every part of our country.

In 2007, a comprehensive review of HSE-funded adult day services was initiated to modernise and reconfigure the services we were providing. The purpose was clear: to bring these services into alignment with the principles of person-centredness, quality and accountability, and to ensure that every adult with a disability had access to supports that enabled them to live a life of their choosing. The review culminated in the publication of the New Directions report in 2012, which marked a radical shift from provider-led programmes towards user-led supports.Under New Directions, services are designed so that adults with disabilities can participate as equal citizens in their communities and contribute meaningfully to those communities. Crucially, the report also states that the new approach must be underpinned by nationally agreed standards. However, work remains to be completed. As part of that review, a census was conducted which highlighted a significant absence of nationally agreed or clear definitions about what constitutes a day service. The report describes services that have developed without the benefit of a coherent national guidance framework or robust quality assurance systems. A consultation engaged more than 1,500 people, including service users, families, service providers and the public, on what is working well and what is not.

In regard to what people want to see in future service provision, the consultation highlighted the striking differences in people's experiences of services and underlined the need for quality assurance systems and support for providers to achieve common standards. Providers themselves argued for quality standards grounded in person-centred principles alongside systems for monitoring services and support to provide them. The New Directions framework established that all service providers must work with the HSE to prepare plans for delivering New Directions within a quality assurance framework that the HSE will develop. That commitment to quality is to be expressed in service standards and in the arrangements made for monitoring and evaluating services. Yet, almost 14 years after New Directions was published, we still do not have a permanent national standard for community hubs and service locations used for day services.

Interim standards were developed by the HSE to check how well adult day services are following New Directions but providers are not yet being inspected against these interim standards. Instead, the HSE has asked all adult day services to self-evaluate their services against the interim standards, with support and training on how to do so. Managers must now start self-evaluations which must include asking stakeholders to rate how their service is doing. Providers must set actions for areas where stakeholders agree there is room for improvement. This process is intended to promote continuous improvement in service quality. Despite this progress, very few positive comments have been made about the buildings or locations used by day services. Many people benefit from their day services but others describe unhelpful or negative experiences. These differences highlight the need for reform, quality assurance systems and support for providers to meet common standards.

I accidentally walked into a community hub and was surprised at how basic it looked, given that the people using the hub had originally been availing of the day services in Stewarts Care, which was providing a high standard of amenities. I asked the Minister when she would instruct her Department to instruct the HSE to establish and publish clear national standards for community hubs and buildings used for day services for adults with disabilities and when those standards would be subject to independent inspection, for example, by HIQA, rather than self-evaluation? We know the interim standards exist. We know self-evaluation is under way. We do not yet have clarity on when nationally agreed permanent standards and an independent inspection regime will be in place.

Adults with disabilities deserve day services that reflect dignity, quality and consistency, as set out in New Directions. It is time to bring this long-promised reform to completion by setting out a firm timeline for standards that ensure quality, safety and inclusion in every community hub used for day services.