Recently I had the opportunity to listen in on the staff conference of an Irish intellectual disability service organisation. Christy Lynch had been invited to set the ‘National Context’ for the day’s discussion. No better man! He continues to visit other countries, and other continents, as supported employment guru; he has recently been elevated to the status of ‘De-institutionalisation Designated Expert’ because of his exhaustive work as Project Leader of the recent Congregated Settings Report. He is currently Chair of the National Federation of Voluntary Bodies, so he flits between meetings with government ministers and service providers. Christy is, of course, CEO of Kare –although it’s hard to imagine that the Lillywhites actually see very much of him.
With that CV, Christy Lynch knows a fair bit about the ‘national context’ of intellectual disability services in Ireland. In his presentation to the staff, he referred to the myriad of current national strategy reports, the Disability Policy Review, New Directions, as well as his own Time to Move on from Congregated Settings, and the lurking although still not published Value for Money Report. With such props setting the scene, Christy posed the stark question: Are existing services fit for purpose? Is the current provision of intellectual disability service sustainable? His conclusion: NO, not in the current economic climate, and with changing demographics and changing expectations.
Services talk (and talk) about person-centred services. Because they have admittedly developed to a considerable extent over the past decades, they do now hear what people want—but they are still not doing what they say! Services need to talk with people with intellectual disabilities and their families about the supports they want—not services, but supports—to enable them to participate in their communities, as citizens, as fully as possible.
Services have too much power. They have traded the ‘medical model’ for a ‘clinical expert model’, in which multidisciplinary professionals assess what is best for service users. But the very near future will involve individualised budgets or individualised funding in some form. Organisations will have to adapt very quickly, to be efficient and responsive and innovative—all those buzzwords combined—to survive in this new world.
Irish disability services cost too much. That’s what our government ministers keep saying. Admittedly, the outcomes from services’ expenditure levels do not compare favourably with those in many other countries. And some of our ‘best’ services—at this time of enforced cost-cutting and new frugality, perhaps they are a luxury that Ireland cannot afford? This presents massive challenges. How can services (whose budgets have been trimmed by up to 15.20% over the past four years) continue to provide supports for their clients—let alone for new entrants—with the additional cut of 184.108.40.206% imposed this year? (In a desperate attempt to avoid staff redundancies and resultant service reduction, this actually amounts to a massive cut of about 8.9% in a budget’s non-salary elements.)
The only response to this challenge for services to get ‘a better bang for the buck’ in the expenditure of disability funding is to reconfigure how supports are given. This will necessarily involve far more flexible working practices in order to give individualised social supports for people how and when they want them, as well as making better use of family and community supports.
The core business of intellectual disability services NOW is to provide individualised social supports for people with disabilities. Their residential needs should be met by social housing services— that is the logic of the de.congregation report, as people move out of institutions and group homes into their own communities. The expertise of ID-trained professionals will be essential in the provision of additional supports for people with significant health needs, in conjunction with the services provided by the much-promised mainstream primary care teams. Social supports will be aimed at supporting vocational training and work opportunities, personal expression and creativity and the development of wider social roles—and in influencing service policy and practice.
Christy Lynch concluded with a vision for the future for service providers, providing:
- Person-centred focus and planning processes for community inclusion and the provision of supports not constrained by 9.00–5.00 service delivery boundaries.
- Ways for service users and families to influence policy/provision and evaluation
- Complying with HIQA guidelines, as reflected in New Directions
- Collaboration and shared learning locally, to make best use of resources in the sector (e.g. staff training and HR management).
For those who remained unconvinced, Christy quoted several relevant quotes: ‘Change is the law of life and those who look only to the past or present are certain to miss the future.’ (John F Kennedy)
‘It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change’ (Charles Darwin)
‘Everybody has accepted by now that change in unavoidable. But that still implies that change is like death and taxes—it should be postponed as long as possible and no change would be vastly preferable. But in a period of upheaval, such as the one we are living in, change is the norm.’ (Peter Drucker)