When we think of service providers, we usually think of the HSE or the Voluntary Sector. How is Nua Healthcare different?
Well, essentially Nua Healthcare is a private limited company or ‘for profit’ entity. This model is quite common in the UK and Northern Ireland, but seems somewhat alien in the Republic, given the historical make up of services in this country.
When we first started the company, we thought a lot about whether we should be a private entity or a charity/voluntary body. I believed strongly at that time (and still do) that individuals with intellectual disability had never really been seen as consumers in Ireland. Why should any individual or sector of society be viewed constantly as the subject of charity, as opposed to consumers of a social/health service? After all, it is much harder to complain when you know someone else is providing you with a service for free or out of charity—even if that service falls far short of your expectations!
I believed that the only way to break this cycle was to get to a point where service users could effectively ‘shop around’ for a product that best suited them. Quality initiatives can only go so far if individuals don’t have the ultimate choice, to move on—if they so wish!
A consumerist model would bring about change. Organisations would have to compete for resources and customers. Poor quality organisations would cease to exist. Good quality providers would prosper and grow. We established as a private ‘for profit’ company for that very reason. We wanted people to ‘choose’ Nua as their provider.
When and why was Nua Healthcare established?
Nua Healthcare was established in the summer of 2004 as a respite service for people with Asperger Syndrome. At that time, there was a significant deficit in services for individuals with High Functioning Autism, Asperger Syndrome and mild intellectual disability. Individuals were very often left without services or catered for in very inappropriate settings. Unfortunately this is still the situation for many people today.
I had been working in the community with some of these individuals, providing home support services and supported employment links. Our services at that time were very effective in alleviating challenging behaviours, but they fell short in meeting the overall need as we were not offering appropriate supports in people’s home settings. When the home situation could no longer cope, therefore, individuals were nearly always referred to institutional settings for residential care. Saddened by this, a colleague and I established the first Nua residential service on the grounds of a farm in County Kildare. The service has since expanded to over 14 residential facilities and 5 day services across the greater Leinster region.
What is different (if anything) about how Nua Healthcare supports people?
Nua is very lucky in that it is a relatively new entity. We didn’t have the legacy issues that other organisations have to face in terms of trying to break up institutional models or practices. We were in a position to provide Person-centred services from day one of the organisation’s inception. We were also very lucky in that we were small and so could change and adapt extremely quickly.
We subscribe to the service model of ‘services without walls’ and ‘not putting square pegs into round holes’. We believe that services should be moulded around each person, as opposed to requiring people to ‘fit in’ to existing structures. This is really evident in how our services have evolved over time. Our first referral was an individual who had an interest in horticulture, so we developed a market garden and community market link. The second individual hated the notion of gardening and so an entirely different service was developed for him. This is what we aspire to do for every individual referred in all areas of need, be it day services, clinical interventions or specific training/social supports.
For parents, one of the primary concerns is about standards. What sort of standards (if any) does Nua Healthcare benchmark against? Are Nua Healthcare services inspected by HIQA?
Nua Healthcare gained accreditation in January of last year through the National Autistic Society (UK). This award gives us the status of being the only autism.accredited service provider in Ireland. Our service was rigorously vetted against 32 general and autism.specific service standards. Accreditation lasts for a period of three years and is subject to ongoing review.
We are not currently inspected by HIQA. As a private entity, however, we are constantly striving to keep standards to a very high level and we welcome the prospect of independent inspection.
Why would someone be referred to Nua Healthcare, instead of other providers?
For a number of reasons .
- Nua Healthcare has built up a level of expertise over the past number of years in the area of supporting people with high functioning autism. We are a quality service with individual specialist facilities and supports as required.
- Nua has a significant track record in providing high support/challenging behaviour services in ordinary community settings.
- Sometimes it’s as basic as the fact that there is simply no alternative provider in the country prepared to accept the particular individual.
Who funds those attending Nua Healthcare?
At the moment, the HSE funds the majority of placements in Nua Healthcare. Funding has (at other times) also come from other state departments (e.g. Justice), private bodies and overseas agencies.
Can people fund their own services with Nua Healthcare?
Theoretically they could, but costs can be prohibitive for individuals and/or families, given the nature and level of supports required. Residential support services are often very staff.intensive and therefore costly. We have had some individuals fund respite services in the past, but for limited periods of time only.
What sort of services does Nua provide?
Nua Healthcare provides a range of services including residential supports, day services, community outreach/home support and assessment services.
People who avail of services with Nua Healthcare present with a broad range of challenges, which include intellectual disability (ID), acquired brain injury (ABI), mental health (MH) issues, challenging behaviour and Asperger’s Syndrome, amongst others. People are supported based on the levels and types of services they require, rather than on a particular diagnostic label.
If one were interested in accessing Nua services, what is the process?
Nua Healthcare will conduct an initial assessment so as we can determine the needs of each individual. This initial assessment can be triggered by a referral from the HSE, a clinician, a family member or a self-referral. Once the initial assessment is complete, Nua Healthcare puts together a proposed support package based on the identified needs and submits it to the appropriate body for consideration.
How do you prevent Nua from becoming just like one of the other services—particularly as you get bigger with greater demands?
This is a very valid question and one that I have always been cognisant of since the organisation’s inception. I have been working for roughly 16 years now in the disability sector and have been lucky enough to have worked in an array of organisations, both big and small. I always believed that the smaller an organisation was, the better the quality of care it could deliver, irrespective of what ‘quality system’ it had implemented.
As organisations grow, so too does the distance between the manager at the top and the person receiving the service. From my experience, people become ‘numbers’ in big organisations and the focus shifts from individual prosperity to the organisation’s prosperity. I strongly believe that service users need to have access to an approachable senior manager who has the skills to relate to and understand their needs.
Of course, as Nua Healthcare grows, I have no doubt we will experience the same challenges as do the large service providers. It will not be possible for me to have a meaningful relationship with everyone we support, as the organisation gets bigger. I believe if we are to retain a focus on the individual, we will have to split the organisation up into smaller ‘pocket-sized’ services, each with its own senior manager who is highly experienced and is totally committed to the ethos on which Nua Healthcare was founded, as well as being capable of developing and nurturing relationships directly with service users.