There are significant changes occurring within day-service provision for people with disabilities. As a result, there is immense confusion and uncertainty on how national policy and operational guidelines will impact on current models of service. This uncertainty has been compounded by two key documents: The National Standards for Disability Services and The Code of Practice for Sheltered Occupational Services. Both of these policy documents await, for some time now, formal approval and implementation.
In the meantime, service providers, service users, their carers and local HSE areas are referencing the detail of these documents as new policy. There is also misunderstanding because of the lack of clear definitions around day-service options. It is within this environment of uncertainty and confusion that agencies have made strategic decisions in relation to future day-service provision.
It is accepted that disability services, and specifically in this context, sheltered work, needed a significant review. The models embraced in what we term ‘sheltered work’ were widely diverse, from care-orientated programmes to highly commercial initiatives. Some models committed to, and endeavoured to, deliver on a holistic and Person-centred approach, while others showed little evidence of any health or social service-related project. We recognise that there are models of sheltered services that align closer to employment type arrangements and expectations. Herein lies the liability for these providers and indeed the Department of Health and Children (DoHC). The physical environments, health and safety practices, remuneration, staffing ratio and complement, staff qualifications etc—all differed greatly. Therefore, it was timely that the DoHC sought to redefine this model of service by establishing a best-practice and uniform standard.
As part of this commitment, the Code of Practice should meet the key principles of the Health Strategy: equity, people-centredness, quality and accountability. These principles would be the intent of all service providers, however the sheltered work models in place were often influenced and directed by other factors, such as inadequate funding, lack of guidance, absence of relevant standards, outside commercial influences on a provider etc.
The combination of uniform national standards and guidelines, increased emphasis on supported employment, and the formation of sheltered employment under Department of Enterprise, Trade and Employment will together hugely address and advance provision. The economy is buoyant at this time, enabling supported employment to be a key component of individuals’ employment needs. It is, from any perspective, the ideal outcome—if an individual has the desire and ability for this form of employment.
However, should the economy take a downturn it will impact on this option and, as a consequence, service users and service providers will need to explore other options. In addition, there will be a number of individuals who, because of health-related matters, aging, immaturity, significant disability or other factors, will not want or aspire to employment in the open market, but who could still require some therapeutic form of activity/work that is meaningful, engaging and progressive for them. There is a danger that the current proposals do not accommodate these needs. The more options we establish at this time, the more Person-centred and responsive services we can provide, including therapeutic types of work. Therefore, an additional option drawn from the strong and innovative models of the past will be very valuable going forward, in order to reflect and meet the needs of all people with disabilities.