Transforming an Intellectual Disability Service

The St. Joseph’s Intellectual Disability Services in St. Ita’s Hospital, Portrane, Co. Dublin have been totally reconfigured with the transfer of 63 patients from dormitory accommodation in the old hospital to a new street of ten houses in the campus, Eileen Kelly, Director of Nursing, North Dublin ISA told the Forum.

The St. Joseph’s Intellectual Disability Services in St. Ita’s Hospital, Portrane, Co. Dublin have been totally reconfigured with the transfer of 63 patients from dormitory accommodation in the old hospital to a new street of ten houses in the campus, Eileen Kelly, Director of Nursing, North Dublin ISA told the Forum.

Eileen Kelly
Eileen Kelly

The genesis of this was in July 2008 when they had a chronic shortage of staff, an inability to meet legislative requirements, overtime running at a very significant figure and the inability of staff to work 14 shifts in a row and still maintain a high quality service, although there were obviously benefits for clients in being cared for by staff whom they knew and who knew them.  The service had a total allocation of €4.9 million a year but costs were running at €6 million.

There were three options – maintain the status quo, convert the additional nursing hours to nursing posts based on the current configuration of services or convert additional nursing hours to nursing posts based on client dependency levels, associated workload index and reconfiguration of the residential service on campus.

It was decided to go for a full reconfiguration and an extensive engagement process was begun with users, families, parents and friends groups, staff and representatives of the PNA, SIPTU and IMPACT.

The objective was to increase the quality of life for service users, transform the way services were delivered, structured and funded, improve the financial outturn and build a successful consultation framework with all stakeholders.

“We converted overtime funding to WTEs, targeted and recruited new graduates, unfreezed staff perceptions of existing service delivery models. We integrated allied health professionals into the service and changed the profile of the nursing service.  It was typically a mature profile without a lot of new graduates entering the service.  We succeeded in marrying the benefits of a college education with experience and we built a new model of service delivery, congruent with need,” said Kelly.

The objective was to increase the quality of life for service users, transform the way services were delivered, structured and funded, improve the financial outturn and build a successful consultation framework with all stakeholders

“Staff engaged in new ways of working, we improved the financial outturn and eliminated our overtime bill, converting it into 40 WTE nurses and allied health professionals.

“Sixty three people moved from dormitory style units to modern homes with individual bedrooms, sharing their home with no more than five others. Restrictive practices were reduced dramatically and now have become almost a thing of the past.

“We also completely reconfigured our day services. In 2010, we had 78 per cent of the residential population accessing a day service.  In 2011 we have 92 per cent of our residential population accessing a day service, with four per cent of the remaining eight per cent choosing not to do so.  We have a beautiful development and clients are happy and engaged with where they are and what they are doing.  Through the Public Service Agreement, we are delivering a substantially increased quality service.”