Dáil Éireann Debate, Thursday - 27 September 2012
3. Deputy Joan Collins asked the Minister for Health the reason the Health Service Executive is still using the medical model of disability assessments; the reason occupational therapists are in total control of budgets and decisions for wheelchair repairs and replacements; the reason the HSE has not moved to a consultative model with the patient when it comes to these matters; and if he will make a statement on the matter. [41146/12]
Amharc ar fhreagraAssessments of people with disabilities are conducted for many reasons. The type of assessment conducted reflects the purpose for which the assessment is being completed. Assessments for mobility aids are generally carried out by an occupational therapist or a physiotherapist. Items which are essential to ensure safety, dignity and independence are prioritised on the basis of the assessment and funded from the disability services budget. However, while assessments, including those relating to mobility aids, are not based on medical diagnosis, the Deputy may be referring to the fact that services for people with disabilities have traditionally been delivered according to the medical model of disability and the fact that decisions on the allocation of resources have rested with administrators and health professionals, rather than with service users.
The value for money and policy review of disability services which was published in July by my colleague, the Minister of State, Deputy Kathleen Lynch, notes that the objectives of the disability services programme have been pursued through an approach based on a medical model of disability which is heavily professionalised, resource intensive and delivered in segregated group-based settings. The review concluded that this model of service was not compatible with the achievement of best outcomes and the exercise of choice and control by the individual. It recommends a significant restructuring of the disability services programme through migration towards a model of person-centred, individually chosen supports and implementation of a more effective method of assessing need, allocating resources and monitoring resource usage. The Department of Health and the Health Service Executive are developing an implementation framework for the recommendations contained in the value for money report, including the move towards a person-centred model of service which will reflect the social rather than the medical model of disability in all facets of disability service provision.
I thank the Minister. He used the words "safety" and "dignity" and referred to medical models which were not compatible. Mr. Dermot Walsh who is present in the Visitors Gallery was involved with the Disability Federation of Ireland's and the HSE's listening and changing, person-centred consultation. It is obviously this to which the Minister is referring. However, this system is failing very badly. Mr. Walsh is a wheelchair user. He uses a Storm wheelchair which is due to be changed as it is seven years old. In the meantime, he is obliged to get it fixed on each occasion on which it breaks down. It is specially adapted to meet the needs of Mr. Walsh who goes to work every day. In July one of the wheels fell off and he was informed that new wheel bearings would be required. He went to his usual engineer to have it fixed but was informed that he would first be obliged to go to an occupational therapist. As a result, he went to see the occupational therapist in Crumlin in an environment with which he was not familiar. He was asked to remove himself from the chair which was then assessed by an occupational therapist who had been only newly appointed and an engineer who was not aware of his needs. The report which was compiled as a result of this exercise stated the wheel bearings would have to be fixed and that the foot plates and arm rests would have to be changed, which Mr. Walsh did not want. He was not involved in the consultation in any way and it is outrageous that he was placed in the situation to which I refer. In the interim, he has been informed by the occupational therapist that he will be obliged to go to Thomas Street in order to have his chair modified. Is this the type of situation in which we want people to find themselves? This man has not been able to go to work because he is afraid to use the chair without the wheel being repaired. He did not want the chair to be changed or modified in a way which did not suit him. His chair was taken from him on Monday last and he has not yet got it back. This all resulted from the fact that he was not consulted about his needs. His life has been in chaos since July.
I am very disturbed by what the Deputy has just told me. We want to support people in maintaining their independence. It is unacceptable, therefore, that a person would not be consulted and that advice would be given over his head on his needs and preferences. I give the Deputy an undertaking that I will have the matter investigated. If a policy directive is required in respect of it, it will be forthcoming. I take the opportunity to apologise to Mr. Walsh for the inconvenience the service has caused him. We will rectify the situation.
I thank the Minister. Perhaps, immediately after Question Time, he might discuss with Mr. Walsh a way in which the matter might be resolved.
Is Mr. Walsh here?
Yes, he is in the Visitors Gallery.
Okay, I will do that.
