Demonstrating change in the provision of Day Services to people with disabilities:

by Brege McCarrick, Disability Services, HSE Midlands


National Seminar, Mullingar Park Hotel, 19 November 2008
In July 2007 the HSE established a Working Group on HSE-funded adult day services for people with disabilities. The aim of the group is to complete a strategic review including a national census of HSE-funded adult day services, research on national and international models of service delivery and extensive consultation with service users and providers. The working group will advise on the reconfiguration and modernisation of services based on best practise, good value for money, better outcomes for service users, legislative requirements and service standards. That’s one tall order.

Originally the working group intended to test/pilot findings from their research and consultation work. However, they had a very tight reporting timeframe which did not allow for a pilot phase. Instead the Working Group decided to host a national seminar focusing on the key themes which emerged from both their research and their consultation:

  • Person centeredness
  • Community integration
  • Collaborative working
  • Development of advocacy.

The Seminar, which was held on 19 November 2008 in the Mullingar Park Hotel, was entitled ‘Demonstrating change in the provision of Day Service to people with disability’.

The National umbrella bodies were invited to nominate examples of day services where the key themes have been developed. As a result fifteen organisations were invited to make presentations at the seminar. The presentations represented all three strands of the disability sector—mental health, intellectual disability and physical and sensory disability. The presentations also reflected both a geographic and an urban/rural spread of services.

The key themes and words running through the 15 presentations to the seminar were person centeredness, community integration, collaborative working and advocacy. These themes and some of the services have been with us for quite a while and are familiar to all of us.

Having listened to the presentations I am in no doubt but that the reconfiguration journey started a long time ago, but we have a lot of work to do to develop speed momentum and innovation on the journey. For every service funder, deliverer and user will need to take a look at their culture, their ethos and their services to ensure that person centredness runs through the veins of our entire system.

In the open discussion sessions we had a number of people calling for the road maps—the way forward, the definitive guide to the future models of day service delivery.

All the old chestnuts were there in the questions too:
◆ Insurance for community-based activities and natural supports
◆ Staff to service-user ratios
◆ Employment conditions
◆ Access
◆ Accreditation and quality standards
◆ Evening and weekend services
◆ The status of the ten-year-old Code of Practice for Sheltered Work

Reflecting on the presentations I have no doubt but that a number of current services are demonstrating change in their day service provision. There was very clear evidence that the key themes of person centeredness, community integration, collaborative working and advocacy are evident in some services. The voice of the service user was particularly strong and in many presentations their voice was the only one we needed to hear. In some services there was a clear focus on person centeredness. Presenters called for guidance and standards, more flexible funding, more innovation.

I was particularly interested in the pithy colourful presentation made by the service users of Midway Meath and SOS Kilkenny. They told us about their independent advocacy services and their studies in Waterford IT for a Certificate in Leadership and Advocacy. They used natural supports in the college—other students to assist their learning and drawings rather than words as a communication tool. They talked about decision-making being handed over to them and their own empowerment. They told us about their fears on the first day in college, everyday things like getting lost and looking for the
canteen and finding it their own way.

The word ‘stop’ was very powerful in their presentation. One presenter—a service manager—said, ‘I’m going to stop everything I started yesterday because it was wrong.’ A second presenter told us of their day of dawning, when they realised current services were not meeting the needs and that ‘I’m going to have to stop doing it that way today.’ What rare, brave and honest statements.

The final report of the review group is due any day now. We expect the report to focus on policy, culture, service, funding and quality. The research papers commissioned by the review group will be available with the final report.

To deliver the change required in day services we need to ensure that the culture of person centeredness goes right through every individual, every family and every organisation. If we can truly deliver on the culture, service models funding structures governance and standards will follow.

And for my New Year’s resolutions I made a list of the things that we started in the past that are not working and have to stop, and those things that I have to do another way. It’s a longish list.