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Ireland's political and cultural magazine
30September/October 2015
T
HERE is a disturbing silence about
people with disabilities in institu-
tions. HIQA has kept plugging
away with its inspections and reports
that document deplorable and unac-
ceptable conditions. But that seemed to
be it, until the HSE finally called for
resources to do what is needed
– deinstitutionalise.
The HSE has just sent a costed sub-
mission to Government to accelerate
implementation of the Congre-
gated Setting report which dealt with
residential settings where people with
disabilities live in the presence of ten or
more other people. It identified that
some €m is needed to deinstitution-
alise, and to offer a community-based
model of care in place of these
institutions.
The media have been largely silent on
the issue. Politics sees no votes in it. The
Irish Human Rights and Equality Com-
mission has yet to make a move. The
National Disability Authority seems to
be in hiding. The NGO sector, even those
advocating for human rights, appears to
have left the issue for Inclusion Ireland
to take up. When it comes to human
rights is it just the rights of some
humans that matter? Then, out of the
blue, the HSE puts it up to Government.
Why has it taken so long?
The Congregated Settings Report
demanded that people with disabilities
should be able to: “live full, inclusive
lives at the heart of family, commu-
nity and society and they should be
able to exercise meaningful choice,
equal to that of other citizens, when
choosing where and with whom they
will live”. The report was clear that
“congregated provision is in breach of
Ireland’s obligations under UN
Conventions”.
At the time of the report, ,
people with disabilities lived in these
congregated settings. One thousand
young people with disabilities are actu-
ally living in nursing homes.
The rate at which people are moving
out of these institutions has been slow.
There is an annual target to move
people. Even this low target is not met,
with about people moving each
year.
The UN Convention on the Rights of
all Persons with Disabilities commits
State Parties to “recognise the equal
right of all persons with disabilities to
live in the community, with choices
equal to others” and requires that they
“shall take effective and appropriate
measures to facilitate full enjoyment by
persons with disabilities of this right”.
Ireland played a central role in the
adoption of this Convention, but we
have yet to ratify it and to implement
this requirement to deinsitutionalise.
The Congregated Settings report rec-
ommended that the Department of
Health ensure that all people with dis-
abilities living in congregated settings
move to community settings within
seven years. It found that these people
“live isolated lives apart from any com-
munity and from families; many
experience institutional living condi-
tions where they lack basic privacy and
dignit y”.
Congregated settings are a violation
of human rights in and of themselves.
They also create the conditions for fur-
ther human rights abuses as can be seen
from the hundreds of HIQA reports that
have identified these centres as not
being compliant with requisite
standards.
We will now get to see what place
human rights really have in the priori-
ties of Government. Will they make this
€m available when the national
budget for disability has been reduced
by €m since ? They have the
money. Will they put it into tax relief or
into fulfilling people’s human rights?
The next budget will be a true measure
of this Government’s respect for human
rights.
The HSE proposal starts with
people with disabilities moving out of
eleven large institutional settings with
significant HIQA compliance issues.
This would cost €.m. The next steps
would involve a further people with
disabilities moving, at a cost of a further
€m. The final step would cover
moving , people with disabilities
from fifty-five settings at a cost, of
about €m. This, it should be noted,
does not address waiting lists for those
in need of care support.
Deinstitutionalisation involves more
than closing institutions, it also involves
developing high-quality and appropri-
ate community services. Until now
deinstitutionalisation has used commu-
nity group housing. This was not
recommended by the Congregated Set-
tings report with its emphasis on
personalised accommodation and sup-
port arrangements.
There is a risk that these community
settings will just reproduce damaging
institutional cultures.
This raises the spectre of the human
rights violations evident in congregated
settings merely being replicated in com-
munity settings.
The HSE has made an important
intervention. The Government is chal-
lenged to respond.
Both must then ensure people with
disabilities choose, receive, and direct
the services and supports they need,
participate in their family and commu-
nity, and have the opportunity to
maximise their full potential in accord-
ance with the recommendations of the
Congregated Setting report. •
People with disabilities in institutions need choices By Niall Crowley
Deinstitutionalise in favour
of community care
POLITICS Community Care
The
Congregated
Settings
Report
demanded that
people with
disabilities
could ”live
full, inclusive
lives at the
heart of family,
community
and society
and exercise
choice over
where they
live
“
that’s more like it
