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Confidential recipient

'They feel there's an unreasonable effort to control them': Watchdog concern over HSE treatment of people with disabilities

In 2018, 206 complaints or concerns were received by Confidential Recipient for Vulnerable Persons.

A HSE WATCHDOG has criticised the health service for denying people with disabilities a role in the decisions made about their care. 

According to the fourth annual report by the independent Confidential Recipient for Vulnerable Persons Leigh Gath, some people have said they were threatened with having equipment or support hours reduced or removed after expressing a desire to have a role in the care provided by health services. 

Gath’s role is to receive and examine concerns and to provide help and advice to vulnerable adults, or anyone concerned about a vulnerable adult in a HSE-funded service.

In her report, Gath criticised the HSE’s use of the medical model of disability instead of the social model which allows for more inclusiveness for people with disabilities.

“In some instances [people] are apparently being forced to use their supports or equipment as the HSE sees fit,” Gath said. 

This excludes people with disabilities “having choices in their lives because it may be deemed ‘risky’ or not necessary,” Gath said. 

“The concerns I have seen on this are coming from adults with physical and/or sensory disabilities who are capable of making their own decisions,” Gath said in her report. 

These people have told me of feeling that there has been an unreasonable effort to control them, and when they have not complied, some people have apparently been threatened that use of equipment or support hours will either be reduced or withdrawn.

Gath also noted in her report that communication issues between the HSE and families remains problematic. 


Today’s report shows there was an increase in the number of complaints or concerns received about the care of vulnerable adults in HSE-funded services last year.

In 2018, 206 concerns or complaints were received, compared to 196 in 2017. However, there was a reduction in the number of safeguarding concerns – down from 90 in 2017 to 76 in 2019.

The majority of concerns and complaints related to issues with disability services – 70% of all concerns received. Some 11% of concerns and complaints related directly to Mental Health Services (both hospital and day-care services) throughout the country.

The type of concerns raised with the Confidential Recipient included:

  • Safeguarding (76 complaints in 2018, down from 90 in 2017)
  • Client placement/planning (34 in 2018, up from 22 in 2017)
  • Access to equipment (10 in 2018, up from five in 2017)
  • Level of staff to support client (30 in 2018, up from five in 2017)
  • Financial charges (three in 2018, down from five in 2017)
  • Staff behaviour (20 in 2018, down from 28 in 2017)

The report highlights a number of case studies that were resolved during the period in question.

One of the cases relates to a woman with severe intellectual disabilities who, after back surgery and a tracheostomy, and was living in an acute hospital.

The service she had previously used was unable to take her back because of the complexity of her medical care and her family were not in a position to take her home.

Gath’s office was notified to the woman’s case in early 2018, today’s report notes. 

A trip to visit her showed me she had no life outside her single hospital room. She was spending her days thumping the padded sides of her bed. That appeared to be her only activity. Her intellectual disability meant she could not understand television, and had no activities to do during the day.

“Needless to say she was having behavioural problems. She had someone employed to sit with her all day – but no activities except for the occasional walk around the corridors in a wheelchair in the evening when the hospital was quiet.”

After bringing the woman’s case to the attention of the HSE, she was transferred to a residential placement where, today’s report notes, “she has settled well”. 

Gath said her office had dealt with almost 750 formal concerns or complaints about healthcare services since it was established in December 2014.

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