A shameful scandal

SERIOUS IMPLICATIONS Western Care’s designation of certain services as ‘unregulated’ has left extremely vulnerable Mayo people unsupported. 

Mayo’s most vulnerable have been let down by Western Care

The Mayo News has been covering ongoing issues at Western Care in some detail since last November.
The Mayo charity is responsible for providing support and care for 850 service users, some of whom are the most vulnerable people in our county. It employs approximately 1,000 staff.
However, in recent months, it has become abundantly clear that all is far from well at the organisation.
CEO Donal McCarthy was relieved of his duties by the Board of Western Care in November. He had previously launched an investigation into the Individualised Services section of Western Care and placed three senior managers on leave.
Following Mr McCarthy’s departure, Western Care said a ‘review of management structures’ was underway.
Health- and social-care watchdog HIQA said in December that it had received ‘information of concern’ relating to Individualised Services and was liaising with Western Care in this regard. New revelations, reported in this week’s paper, confirm that HIQA’s concerns are serious.
While huge concerns exist across the board at Western Care over governance and culture – as articulated by the 40-plus current and former staff members and service users’ families to whom The Mayo News has spoken – the origin of the current troubles is the Individualised Services (IS) section of Western Care.
IS provides supports for people living in their own or rented accommodation. Crucially, the vast majority of IS services are unregulated. This means they are not monitored by HIQA.
In what must be viewed as a glaring flaw in legislation, providers like Western Care get to determine themselves whether a service should be monitored by HIQA or not.
The Health Act (2007) sets out the parameters. In short, these parameters mean that a service does not need to be regulated if the service user is capable of and allowed to exercise considerable control over their living arrangements.
It is clear from talking to staff and families that many of those in unregulated settings simply do not have the capacity to exercise such control: They should have been under HIQA scrutiny but were not.

HIQA standards
Running a HIQA-monitored service is often more costly, as the body will insist on certain non-negotiables. It insists on suitable living environments, adequate staffing and suitable supports for the service user. From testimonials, plenty of service users in unregulated IS settings were not getting these basic services.
Western Care allowed unregulated services to become the norm in IS, and questions must be asked about who knew and willingly signed off on this in senior management in the organisation and in the HSE, and about who fund the vast majority of Western Care’s budgets.
Was cost a key consideration in this decision? What were the other considerations? Western Care has not answered these specific questions to date.
Many staff members have said that the culture in IS is very much against the use of allied supports like behavioural supports, psychology, OT and speech and language. This has led to two questions being repeatedly raised by staff: Did management in IS want to keep costs down? And was management also not keen on letting ‘outside eyes’ observe what was going in IS?
Concerns about IS are not new to the top table in Western Care. In October 2020, the Wolfe Report, commissioned by Western Care, gave a damning assessment, saying IS ‘is very much in a significant crisis situation’ and detailed the ‘high risk’ of staff burnout and staff injury.
A series of 14 recommendations were made but the report was never made public.
HIQA asked questions about IS in 2017 and also in October 2021, a year after the Wolfe Report was published. It asked Western Care to review whether the unregulated services in IS met the criteria for HIQA oversight and required regulation. Both times, Western Care said the unregulated IS services were akin to home supports, implying that such service users were living quite independently.
Given what this newspaper has learned about the profound challenges several service users in such settings face with their diagnosis, a description of ‘akin to home supports’ is strange. Several such service users require full-time care, some on a 2:1 staff-to-service user ratio.

Legislation flaws
HIQA, to be fair, was hamstrung. Unless it has concrete information of concern, it cannot inspect unregulated services. It finally received such information in October 2022 – and matters have snowballed since then.
This highlights another glaring flaw – that HIQA does not have the authority to inspect an unregulated service without the service provider’s permission, regardless of whether substandard service is suspected or whether the very characterisation of the service as qualifying for being unregulated is in question.
After receiving the information of concern, HIQA asked Western Care if it could inspect five unregulated services. HIQA found that each and every one of the five services inspected required regulation, completely undermining Western Care’s assessments in 2017 and 2021.
Since then, it is believed that concerns over a much greater number of services have emerged.
Western Care now believes it has 47 unregulated services in IS that meet the criteria for HIQA designation.
It is a staggering number.
Mayo Sinn Féin TD Rose Conway-Walsh is to be credited for doggedly pursuing this issue when it could have been easier to turn the other cheek. The public-interest imperative in this story is extremely significant, and it needs to be taken very seriously by the Minister for Health, the Government at large and the HSE.
Put simply, what has been allowed to happen at this Mayo charity charged with providing care for some of the most vulnerable people in our county is a scandal.
Good people who have raised serious concerns have been treated like pariahs.
There seems to have been little to no accountability for those who willingly allowed such a situation to perpetuate for years.
Those involved should hang their heads in shame.