Nicky McFadden (Longford-Westmeath, Fine Gael)
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Question 36: To ask the Minister for Health if he will give an assurance that medication is not being used to subdue patients exhibiting challenging behaviour at residential institutions; and if he will make a statement on the matter. [17858/11]

Kathleen Lynch (Cork North Central, Labour)
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The use of medication in residential institutions operated by or on behalf of the HSE is governed by medication management policy and procedures that comply with legislative and regulatory requirements and best practice guidelines. It should not generally be used as a restraint or to subdue patients, or administered for reasons other than medical necessity and as prescribed by a medical practitioner legally authorised to do so. Under the Service Level Arrangements agreed by HSE with all disability service providers, governance arrangements require that care is service user centred and appropriate clinical governance and audit arrangements are in place.

The HSE is committed to providing safe and quality care, and it has put in place a range of standards, guidelines and procedures to protect all service users, with a particular focus on children and vulnerable adults, from potential abuse or harm. The most recent development in ensuring best practice in this area is the Standards and Guidelines for Health Service Providers for the Prevention of Harm to Health Service Users: CARE SAFE, which recommends that restraint may be used as a therapeutic intervention in a variety of care settings, including older persons' services, mental health services, disability services and children's services. The Care Safe Standards and Guidelines were developed to address the risk of abuse or harm to all health service users but particularly for defined vulnerable persons while in receipt of health care services from HSE service providers. The standards and guidelines cover the following areas:

·Protection of Service Users

·Human Resources and Service providers Conduct

·Consent

·Providing Services, clinical interventions and treatments

·Medication, Restraint and Managing Challenging Situations

·Wills and associated financial management issues

Care Safe is currently being piloted in nominated areas in the country involving all of the care groups, including Disability. The outcome of this process will further inform full implementation.

The requirement for the use of restraint can arise in a number of different circumstances and is only used in exceptional circumstances as an intervention of last resort. In this context, restraint can be defined as any physical, chemical or environmental intervention used specifically to restrict the freedom of movement of a person. It is a requirement that all managers within the health service ensure that service providers are aware of the Care Safe Standards and Guidelines. Managers within the HSE, and of all organisations which provide services on behalf of the HSE, are required to ensure that service providers (including all front line staff and support staff) have an appropriate written policy on the use of restraint in place in that setting, and that their agents are aware of the standards and guidelines outlined above.