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The HSE recently published a review of the implementation of the Time to Move On report from 2012 to 2017. Time to Move on from Congregated Settings – A strategy for community inclusion is a model where people with disabilities are supported to move from congregated settings to their own homes in the community with the supports they need. The review was conducted by Ms Suzanne Moloney, Chair of the Time to Move On subgroup and HSE Project Lead.
The original Time to Move On report identified that in 2008 approximately 4,000 individuals with disabilities lived in congregated-type settings. The report found that there were a significant number of people still experiencing institutional living conditions, where they lacked basic privacy and dignity and lived their lives apart from any community and family.
Comments in the original Time to Move On report suggested that the overall funding dedicated to residential services at that time, should be sufficient to support people in community-based residential services, without the need for additional resources. This is often referred to as a “cost-neutral basis”. However, there are a number of underlying caveats and dependencies that have worked against this premise. These include, for example, transitional and seed funding requirements and the fact that responsibility for the delivery of certain supports rests outside of the disability providers. According to Ms Moloney, since the original report was published, the potential to achieve significant change within the existing funding on a cost-neutral basis has also been eroded due to reductions in core revenue funding through years of austerity measures; an ongoing demand for new additional residential placements; and additional revenue funding since 2008 for new or enhanced residential places.
“However, it can be argued that the most critical factor impacting the capacity of the disability sector to reconfigure under Time to Move On within existing resources, has been the parallel issue of the quality and standard of the services being delivered,” according to Ms Moloney.
The Time to Move On report was developed over the period 2008-2011, several years before the introduction of the National Standards for Residential Services for Children and Adults with Disabilities and the commencement of regulation by HIQA in late 2013. The Time to Move On report did not consider the impact of regulation across residential services.
“Despite the financial challenges outlined and the welcome emphasis on the introduction of quality standards in residential services, progress has been made. HIQA have worked with providers and the HSE around registration and compliance issues to support the process of decongregation,” the report states.
Since 2014 a number of innovative projects have been funded through the housing sector to test and demonstrate the feasibility of different approaches in relation to the funding, design and configuration of housing for people with disabilities. Building on this, the Department of Housing committed funding in 2016 and 2017 under the capital assistance scheme for the delivery of homes to support people transitioning from congregated settings. Over this period more than €8.8 million had been approved for properties to support those moving. In 2016 the Department of Health made a commitment to a Disability Capital Programme of €100 million dedicated to the provision of accommodation for those individuals moving from congregated settings to homes within the community over the six-year period 2016-2021. A total of €40 million was allocated during 2016-2017, specifically targeted and aligned to ensure that appropriate homes will be secured for the people engaged and planning their transition to the community from the settings prioritised for decongregation. At the end of 2017 there were 89 properties completed or being progressed so far under this funding.
The original report identified that 4,099 people were living in congregated settings in 2009. The data indicates that by 2012 there were 3,401 people still living in these settings. This figure fell to 2,370 by the end of 2017, which is 1,021 fewer people or a 30.1 per cent decrease in the total congregated setting population from 2012-2017. Since the policy commenced 661 people have been supported to transition.
Ms Moloney stated the vast majority of the early gains made in transitioning people to the community came about in services that made an intentional decision to decongregate particular locations. Falls in the number of transitions occurred in subsequent years, as in 2014 when the services diverted their attention and resources towards achieving regulatory compliance.
Ms Moloney wrote that clear and effective leadership is instrumental in bringing about and fully supporting change.
“Where there is clear leadership with good communication and engagement, staff teams and other key stakeholders can be supported to engage in the process and find and agree solutions that work at local level, without the need for escalation,” according to the report.
Also, the learning from the sites that have progressed decongregation is that communication with stakeholders must be prioritised and be an ongoing process that is actively managed at all stages.
As can be expected with a significant change programme of this nature, obstacles arise that can negatively impact the rate of progress.
“Over the years these challenges have primarily been driven by organisational and structural issues and have included: Changing organisational culture; resistance from stakeholders; the complexity of reconfiguring staffing arrangements; skill mix; capital and adaptation costs; ongoing revenue costs; regulatory pressures; and accommodation challenges (reflecting challenges across the total housing market),” according to Ms Moloney.
“As challenges will inevitably continue to emerge, work will continue at both a national and local level to ensure that solutions are found and shared, which will support the ongoing implementation of the policy.”