The healthcare watchdog has criticised poor governance and oversight of residential disability centres run by the Health Service Executive (HSE) in Co Donegal, which a review found could fail to prevent future serious safeguarding incidents.
The Health Information and Quality Authority (Hiqa) identified a number of shortcomings following a “very serious” safeguarding incident in a HSE disability centre that took place last year.
Disability services in Co Donegal have been under scrutiny following previous revelations of extensive sexual abuse of residents by another resident in the HSE-run Ard Gréine Court campus.
A report completed by the National Independent Review Panel (NIRP) in August 2020, found that the former resident, given the pseudonym Brandon, perpetrated at least 108 sexual assaults on upwards of 18 intellectually disabled adults, most of them non-verbal, between 2003 and 2016.
In October 2021 Hiqa was notified of a separate safeguarding incident in a HSE-run centre in Co Donegal, which it described as “very serious”. The incident had occurred in July 2021 but Hiqa had not been notified until October.
An unannounced inspection of the centre in November found there had been a failure to follow safeguarding policies and procedures in response to the incident.
Safeguarding plan
Inspectors found there had been a three-month delay putting together a team of professionals to develop a safeguarding plan “to ensure the safety of the resident involved and others”.
The regulator said on foot of the “serious” safeguarding issues it escalated concerns to senior HSE staff and began its own regulatory review.
Hiqa’s review, published on Friday, found there was a “heavy reliance” on individual people in charge of HSE disability centres in Co Donegal “without sufficient accountability”.
The watchdog said this “significantly increased the risk of safeguarding or other issues arising and not being identified and responded to in a timely manner”.
Hiqa carried out inspections in 18 of the 30 HSE residential disability centres in Co Donegal in January 2022, with several other facilities having been inspected in previous months.
The review found there had been previous times when the HSE took action to improve safety standards in certain centres, “but then failed to ensure that those improvements were sustained”.
The regulator said “of particular concern” was the fact the HSE’s own “surveillance and oversight” of its centres had failed to identify issues.
The watchdog said previous improvements in HSE-run centres on the Ard Greine Court campus “had not been sustained” and had led Hiqa’s chief inspector to issue several warning letters in March 2021.
There had been a failure to comply with “a range of regulations including safeguarding issues relating to failure to protect residents from the impact that behavioural issues were having on their safety and quality of life”.
The HSE was warned a failure to make improvements would result in the centres being shut by the regulator.
Oversight
Overall, the Hiqa inspections found that the HSE needed to improve the effectiveness of its oversight of residential centres.
“Inspectors found that the supervision and governance of centres from middle management and senior management was poor,” the review said.
There was a lack of clear understanding about when matters should be reported to authorities, which created “a risk that not all serious safeguarding risks would be identified and appropriately escalated”.
The quality of internal audits and checks were “generic and poor” in identifying specific risks, and formal supports and supervision of people in charge of facilities as “inadequate,” the review said.
“Should there be failure to address these poor governance and oversight arrangements, it remains conceivable that another safeguarding incident may occur similar to that which was identified in November 2021,” the review said.
It also highlighted poor communication between the different HSE management levels in Co Donegal.
In one case management in a centre had escalated a “significant” risk about their premises to senior management, but received no response.
When inspectors questioned senior managers they outlined a detailed plan had been made to address the problems, but had not been communicated to the centre staff.
There were also problems with residents still living in “institutional” settings in old buildings. In one centre water leaked into a resident’s bedroom when a shower was used in the floor above, with staff having to mop the floor of the resident’s room each time the shower was used.
The problem had been escalated to senior management in April 2020 but had not been resolved 18 months later, the review said.
In a statement, the local HSE area covering Donegal said it “continues to ensure that safeguarding practices and supports are implemented in line with national policy”.
Edel Quinn, head of disability services for the area, said the HSE “will continue to work to ensure that robust governance, quality and safety arrangements are in place and that these systems are working effectively”.
“We will continue to advocate for the further development of services for people with disabilities ensuring that accommodation and supports that best meets residents’ needs are in place,” she said.
