Paul Coghlan (Fine Gael)
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I welcome Minister of State, Deputy Jim Daly. I call Senator Mulherin.

Michelle Mulherin (Fine Gael)
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I welcome the Minister of State to the Chamber. I am seeking clarity and reassurance from the Minister of State for residents of Áras Attracta, Swinford, County Mayo, and their families on the future of their residence at the Áras Attracta site. After the terrible revelations in the RTÉ report in 2014, the McCoy report was commissioned. One of a number of recommendations in the report when it was published in September 2016 was that the residents in the facility would be placed in the community over a five year period. I understand some residents have moved, but most are stillin situ. Will that recommendation be adhered to to the letter of the law? To what extent will families be consulted? In the case of the particular resident whose details I have supplied to the Minister of State, the family have not been consulted and they do not know what is happening, nor does their brother who is a resident in the facility. Does the Minister of State think it is a fair and proper way to proceed?

In the survey done leading up to the report, it was found that the majority of residents were very happy in Áras Attracta and with the care they were receiving, as were their families. Most of the residents are over 60 years of age and most have lived in Áras Attracta all their lives. There is a fear and a concern that people will be forced into the community against their wishes. This also ignores the fact that Áras Attracta is the residents' home, that some people have complex medical needs and that the community may not be the place for them. They are getting older and these conditions are not improving.

I also note that it is current policy to put people with intellectual disabilities into community settings. I understand that but we are talking about an older cohort of residents here. I know that for the most part, no new resident has been admitted since 1992. This facility opened in 1988. There is a case for residents and families to be listened to. In our drive to modernise, the focus should be on making sure that Áras Attracta is safe, secure and provides the necessary social and medical care.

I mention the various recommendations, including more activities for residents and that residents be given an opportunity for education and so on and issues around the physical building, including that two people should not share a room. All these things can be addressed on site. A statement needs to be made because there has been an awful lot of speculation about this. I would like a commitment that no residents will be placed in the community if they and their families are not in agreement with it. The Minister of State would allay a lot of fears if that commitment was given. After that, I would expect due consultation and a commitment in respect of the facilities there which need to be upgraded. There is a swimming pool there and, as I understand it, it is rarely, if ever, used. There is a lot of potential in Áras Attracta. It is a fine facility and it has given great service to the area, notwithstanding what happened. What happened, in terms of what gave rise to the report, means that work must be done to address those issues. I am not convinced that placing people in the community is a meaningful development in their care or a meaningful step towards improving their circumstances.

Jim Daly (Cork South West, Fine Gael)
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I thank Senator Mulherin for raising this important issue. I begin by emphasising the Government’s strong commitment to the provision of appropriate residential care to people with disabilities. Congregated settings are those defined as a residential setting where people live with ten or more people. Áras Attracta is an old style congregated setting and this Government is committed to working with residents to move them out of these types of settings and into independent community living. Institutional care is not in keeping with best practice and at its worst it breaches an individual’s basic human rights. International evidence also demonstrates that the outcomes for individuals are always better in the community. Key to this is personal choice. Individuals may choose to live on their own in an apartment-type residential setting, others may choose to live with a number of close friends and others with more significant needs may require homes that are purpose built. There cannot be a one size fits all approach. The level and configuration of the supports should meet the needs of individuals and support them to live a life of their choice.

At the end of December 2017, there were fewer than 2,400 people with a disability living in congregated settings. The HSE has prioritised the transition of 170 people in 2018 under its service plan. I understand that Áras Attracta has been identified as a priority case. All residents will move over the next few years to a home in the community and the Áras Attracta campus will close as a disability service. I am informed by the HSE that a number of houses throughout County Mayo have been purchased. These will be refurbished while there will also be some new properties built to suit residents' needs. The work on the first of these houses was completed and the first house opened in November 2017. Since then three more houses have opened with the fourth house expected to open next month. There are advanced plans to open a further six houses in 2018 with a further four planned next year.

The McCoy report published in 2016 highlighted a significant number of shortcomings in regard to residents’ safety, care and well-being. The HSE has put a large amount of time and resources into addressing these issues in the intervening years. In recent inspections of the campus, the Health Information and Quality Authority, HIQA, has confirmed evidence of definite improvements, noting that the HSE has demonstrated a governance regime that will ensure quality and safety. Most importantly there is evidence of a transformation leading to an enhanced

quality of life for residents. Notwithstanding these important improvements to the safety and well-being of residents, it is still the case that international evidence demonstrates that the outcomes for individuals are always better in the community.

The HSE continues to work with registered housing bodies, Mayo County Council and other stakeholders to identify further accommodation to facilitate the decongregation of Áras Attracta. The HSE is working to ensure that the process of transitioning to appropriate living in the community is underpinned by meaningful engagement with residents, their families and key stakeholders.This engagement becomes more active when a home is identified for a resident. I am informed by the HSE that the resident mentioned by Senator Mulherin in her question will not be moving to a home in the community this year. All residents at Áras Attracta will move over the next few years to a new home in the community and the HSE is working with residents and their families throughout this process.

Michelle Mulherin (Fine Gael)
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I am very concerned about the proposals relating to the community setting. The Minister said that addressing issues at Áras Attracta was a priority for the HSE but, just a couple of months ago, HIQA was threatening to close down the facility, despite all the investment there has been. HIQA withdrew its plan but the facility was clearly not achieving the desired outcome. What faith can we have that things will be sorted out in a community setting? I do not believe that people at this stage of their lives should be forced into the community. The individual to whom I refer has autism and a number of complex needs and living in an unfamiliar environment is a traumatic experience for such a person.

I do not see any sense in the plan. I respect experts but these are people who have been institutionalised for most of their lives. They are not of the younger generation, who might be better treated in the community. I worked in a hospital similar to Áras Attracta for five months a number of years ago, where I dealt with people with profound intellectual disabilities. They tried to implement the same policies as we are trying to implement in Ireland and I am not convinced they are for everybody. If we are to go beyond lip service and give the residents care and privacy, we owe it to them to upgrade Áras Attracta and to allow those who want to remain there for the rest of their days to do so. We should make it a healthy and happy environment for them as that is the humane option, rather than what is being suggested at the moment.

Jim Daly (Cork South West, Fine Gael)
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None of us has a monopoly on wisdom or always knows the right things to do in these cases, as they are difficult and change is always difficult. However, we have to be guided by best practice internationally and research shows that people thrive outside congregated settings in communities, where they will still be supported, assisted and helped in communal living accommodation at which they will also have company. The decision to move away from congregated settings was taken a long time ago and it is not just an issue for Mayo - it is an issue for the entire country. It is a challenge and change is difficult, particularly for the residents in this case but they will be at the forefront of the minds of people in the HSE as they make their decisions.

People sometimes have to transition, such as when they leave their own homes to go to nursing homes, and transition is part of change. We have to look to the best interests of residents and that sometimes means moving them to new community settings to be supported and assisted. The change will have to be managed but it has been done very successfully in many other areas and it can and should be done in Mayo.