The more vulnerable you are, the less protection you can expect to get in State-run institutions. That is the conclusion pointed to by reports from the Health Information and Quality Authority (Hiqa) dealing with residential centres for people with disabilities and from other inspection regimes. Fewer than one-in-ten centres for the disabled have met with official standards during the past three years. It is part of a pattern of neglect, cultural abuse and inadequate management that is replicated in many long-established institutions.
The latest Hiqa report found a Kilkenny centre for the disabled to be understaffed, inadequately resourced and unclean. The situation at Swinford in Co Mayo is uncertain, following an RTÉ report on the physical abuse of inmates there. The quality of care at 20 – out of 75 – State-run centres is so inadequate that they face the threat of closure. It is not all about money. Standards of management and staff behaviour are unacceptable and the rights of 8,000 vulnerable residents are threatened as a consequence. Hiqa has repeatedly asked the Health Service Executive (HSE) to monitor the services it provides and to scrutinise its spending processes. While the HSE has "welcomed" these reports, questions involving management and staff accountability rarely arise.
It is clear that, in the absence of accountability, little will change. Culture eats change for breakfast. During recent decades, the demands and practices of public sector workers have tended to dictate the quality of the services provided, to the detriment of users. The fairly recent introduction of specific standards of acceptable treatment and inspection regimes, while accepted in theory by workers, are resisted in practice.
Hiqa is doing what legislation requires. Its job is to defend the rights of disabled individuals, nursing home patients and hospital inmates; to uphold their health and welfare needs and to report on facilities, management and resources. To be effective, however, its reports must have consequences. The HSE recently attempted to suppress trenchant criticism relating to the Midland Regional Hospital in Tullamore. Publication should not be the end of that matter. If the HSE fails to take action, the buck stops with the Minister. The ultimate arbiter will be the electorate.
Standards of professional treatment, care and cleanliness in institutions ranging from hospitals to nursing homes, from disability centres to prisons, appear to be on a sliding scale, dictated in large part by traditional values. Some workers appear unable to distinguish between what is required under modern standards of best practice and established behaviour from the past. It may take time, but images of reports mouldering on Departmental shelves while officials and politicians shrugged in response to administrative failures should spur reformers on.