Workshop Attitudes to Disability Survey

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Standards for Disability ServicesImplications
for Staff

Erik Koornneef, Senior Standards Officer
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About the National Disability Authority.

• Remit National Disability Authority (NDA)
• Policy
• Develop, coordinate and advise on policy
• Research
• Undertake and commission research
• Standards
• Develop and monitor standards and codes of
  practice

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About the National Disability Authority.

• National Disability Authority (NDA)
• Commissions Report - Strategy for Equality
  (1996) signals change
• Establishment of the NDA as an independent
  statutory body in June 2000
• Operates under the aegis of the Department of
  Justice, Equality and Law Reform
• Employs more than 40 staff
• NDA Board

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About the National Disability Authority.

• Recent NDA Standards Work
• Excellence through Accessibility Award Oct. 05
• Guidelines to Person Centred Planning Oct. 05
• Code of Practice on Accessible Public Services
  Oct. 05
• Accessibility Guidelines for Public Transport
  Operators Oct. 05

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About the National Disability Authority.

• Library service
• Open 5 days a week
• Biggest library in Ireland on issues affecting
  people with disabilities

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Standards - background

• What will happen if there are no quality systems?
  Or if the service provided is of a low quality?
  What happens when quality fails?
• Recent headlines
• Majority of users of mental health facilities
  unhappy with standards (Irish Times, 14 Dec. 04)
• Concerns at delay in standardising disability
  care (Irish Times, 8 Dec. 04)
• Child care staff unqualified, says report (Irish
  Times, 30 Nov. 04)
• Abuse of eldrely a growing problem, nurses warn
  (Irish Times, 13 Oct. 04)
• Quality often goes unnoticed until it is absent
  (Humphreys et al, 2000)

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Standards - background
Economy value for money (Funding
requirements) Effectiveness outputs (Customer
requirements) Efficiency processes
(Organisational requirements) (see also
Ovretveit, 2000)
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Standards - background

• Lowering of costs
• Higher levels of customer satisfaction
• Improved performance
• Accountability and the protection of safety
• Increased efficiency
• (see also Reeves and Bednar, 1994 and
  Parasuraman et al, 1985, Sureshchander, 2002)

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Standards Bodies
Health
Education
FETAC
Inspectorate
HIQA
MHC
NDA
SSI
Employment
NAC
FÁS

• Health Boards
• Nursing Homes Inspections
• Pre-school services Inspections

• Other Sectors, such as
• DELG Building Inspectors
• HSA Workplace Safety Inspections

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National Standards for Disability Services

• The standards will apply to services for children
  and adults with
• Autism
• Intellectual
• Physical and/or
• Sensory disabilities
• This includes services provided by health boards
  and voluntary agencies, such as
• Day Residential / Respite
• Rehabilitative Training Home Support services
• Sheltered Occupational Services

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National Standards for Disability Services

• Partnership Health NDA
• 2 years development
• Extensive consultation

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National Standards for Disability Services

• 26,000 people with an intellectual disability
  registered on the Intellectual Disability
  Database
• Estimated 38,000 people with a physical/sensory
  disability
• Funding 1.2 billion Euro per annum (DoHC)
• Approximately 500-600 service providers

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National Standards for Disability Services

• Aims
• That the safety, dignity, independence and well
  being of service users are protected and promoted
• That person centred service provision is
  established and nurtured in our services
• That all services in Ireland are provided to an
  agreed level of quality and performance and,
• That the level of quality is consistent on a
  national basis

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National Standards for Disability Services

• Health Strategy (2001) Quality and Fairness
• to date many quality initiatives have been
  undertaken, although not necessarily as part of
  an overall co-ordinated plan
• Partnership with Dept. of Health Children (July
  2002)
• Advice from the NDA Standards Advisory Committee
• National call for submissions (Sept - Nov 02)
• Analysis of 512 submissions received (Sept - Dec
  02)
• Draft 1 National Standards for Disability
  Services (Jan 03)

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National Standards for Disability Services

• Drafting and consultation (Jan. 03-June 03)
• Launch first draft (Jan 03)
• Regional consultation meetings (Feb.-March 03)
• Attended by more than 500 people
• Written submissions (March 03)
• More than 60 submissions received
• Development of an Audit Tool (April 03)
• Advice from Research Advisory Committee (May/June
  03)

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National Standards for Disability Services

• Pilot and Evaluation (Sept. 03-April 04)
• 20 service providers
• Mix in size and range of services
• Total population 1,500 service users and 1,300
  staff
• Almost 500 interviews took place with service
  users, families, managers, funders and staff
  members
• Excellence Ireland - external assessment body
  commissioned by the NDA for the Pilot
• SECTA Consulting (Prof. Roy McConkey) external
  evaluation

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National Standards for Disability Services

• Consultation and finalisation (April
  04-present)
• April 04 Consultative Seminar
• May-June 04 Final submissions
• Summer 04 Amendments
• Sept. 04 Final version of standards presented to
  the DoHC Standards Working Group, Standards
  Advisory Committee (SAC) and NDA Board
• April 05 Health Service Executive (HSE) Service
  Plan identified 'compliance with the National
  Standards for Disability Services' as one of the
  three key issues for disability services in 2005.

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National Standards for Disability Services

• Five Dimensions
• Person Centred Services
• maximising participation and social inclusion,
  rights, person centred planning, privacy,
  confidentiality, supporting independence, etc.
• Good Governance and Committed Leadership
• internal governance, service planning, quality
  improvement, legal requirements, integration,
  waiting lists, discharge and transfers
• Dignity at Work
• equality legislation, recruitment and selection,
  training, retention
• Effective Communication and Information System
• Safe Environments
• health and safety legislation, behavioural
  support, first aid, risk assessment

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National Standards for Disability Services

• 65 Standard criteria each cr. has a number of
  indicators
• Distinction between Core and Service-specific
  standards
• Distinction between Essential and QI Criteria
• Assessment methods
• Observation (20)
• Documentation Review (30)
• Interviews with users, families, staff and
  funders (50), semi-structured, consent process,
  representative samples, accessible audit tool
• Asssessments to be undertaken by a team of
  experienced and trained external assessors,
  including people with disabilities

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National Standards for Disability Services

Preparation by service provider
External Assessment
Recognition
Approved
Approved with Quality
Approved with Excellence
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Examples

• Standard Cr. - essential
• 1.12 You are encouraged and supported to develop
  and maintain your independence.
• Indicators
• The assessor confirms (Observation)
• Service users confirm (Interview sample)
• Can you choose your own daily routines, such as
  meal times, daily outings, bed times, etc.? Do
  staff help you to do things yourself?
• Staff members confirm (Interview sample)

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Examples

• Standard Cr. - essential
• 3.8 The organisation values and respects all
  staff and volunteers
• Indicators
• Staff members confirm (Interview sample)
• Are there opportunities for you to express your
  views and opinions? Are you satisfied that your
  views and opinions are being heard? Are you
  satisfied that your contribution is valued?
• Documentation

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Conclusions

• Standards should focus on ensuring that services
  are provided, organised and designed around what
  is important to the service user
• 2. Standards should measure the impact of service
  provision on key stakeholders
• 3. External assessments will be carried out be a
  team of independent, experienced assessors

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Next steps hand over

• New health legislation
• Health Information and Quality Authority Cork
• Quality setting standards/provide guidance
• Develop, analyse, disseminate information
• Oversee, implement, support continuous
  improvement
• Health technology assessment
• 2. Irish Social Services Inspectorate Dublin
• Extension of statutory remit to include
  inspections of residential services for people
  with disabilities and the elderly

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Implications for Staff

• Soon, all disability services funded by the HSE
  will have to comply with the standards
• Awareness raising and information sharing
• Training
• Policy and Practice
• Exposure to regular assessments and inspections

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Contact

• Erik Koornneef
• Senior Standards Officer
• National Disability Authority
• 25 Clyde Road
• Dublin 4
• 00353 1 608 04 00
• ekoornneef_at_nda.ie