Updated: Jul 3
By Ailbhe Conneely - RTE News - 23.06.2023 The 'Emily' Report is a disturbing review by the National Independent Review Panel (NIRP) into the suffering and trauma of a woman whose bravery led to the conviction of her abuser. It is the second report in recent years that has referenced the need to move from a medical model - where people are seen through the lens of their disability or illness - to a social model of care which puts the person and their needs at the centre.
The National Independent Review Panel (NIRP) was established in 2017 to review the most serious incidents within the HSE and HSE-funded services. In December 2018, it was commissioned by the HSE to complete a review into serious incidents of concern at services for intellectually disabled people in Donegal.
It found there were 108 incidents of sexual abuse against at least 18 intellectually disabled residents, by another resident 'Brandon' with "the full knowledge of staff and management at the time".
In the Brandon Report, the NIRP recommended a social inclusion model embodying a human rights based approach to person-centred care and community integration. A move to such a model would mean a greater emphasis on person-centred care.
"This would require a change in management structures, working practices and most important of all culture. The HSE has informed the NIRP that they have commenced this process of change," it said.
The HSE made assurances that there were dedicated safeguarding resources and procedures in place. Since then, safeguarding notifications have increased. According to its latest statistics, the number of elder abuse reports to the HSE rose to over 4,000 reports.
The 2022 National Safeguarding Office Annual Report published last week showed a 32% increase in safeguarding reports in relation to people aged over 80, compared to 2021. However, it should be noted those increases were referred from voluntary agencies and the figures remain low by international standards.
Dig deeper into that report and it’s clear that while overall safeguarding reports are up, there has been a consistent drop in reports by nurses for example, from 26% in 2016 to 5% in 2022.
HSE Primary Care staff were responsible for 11% of all reports made by 2016, but that figure fell to 5% in 2022. In 2016, 6% of hospital staff reported concerns, which fell to 3% in 2022.
Those declines are despite the development of safeguarding policies, a national office as well as safeguarding and protection teams.
Meanwhile, there are calls for the implementation of adult safeguarding legislation. Without it, older or vulnerable adults in nursing homes and disabled services cannot be protected. Safeguarding legislation would compel teams on the ground to report incidents - which are happening.
In February, HSE National Director of Community Operations Yvonne O'Neill wrote to HSE Chief Officers noting that in recent years, "of the small number of reported sexual safety incidents", some have been "at the most serious end of the spectrum of physical sexual assault".
She said the primary objective was to continue the prevention of sexual safety incidents.
Ms O'Neill said relevant policies such as risk and incident management, as well as safeguarding, set out important principles.
How those policies and related local procedures would be operated regarding sexual safety incidents "were to be clarified" in a national Sexual Safety Policy for Approved and Designated Centres.
Three years on from the assault on Emily and 18 months on from the publication of the Brandon Report summary, the question is - why is a HSE sexual safety policy still only in development?
Were it not for the cognitive clarity, emotional strength and bravery of Emily, the criminal behaviour of 'Mr Z' on the night of 3 April 2020 would not have come to light.
The fact that staff in the nursing home found it difficult to conceive that the rape of a resident could occur, and that it took one individual to accept it on the grounds of forensic evidence is worrying. Will public representatives finally recognise the need for legislation to protect some of the most vulnerable citizens who are so often voiceless in these situations?
In November, the Department of Health confirmed that it would launch a public consultation on a safeguarding policy initiative early this year. However, in a response to the Sinn Féin TD Patricia Ryan on 23 May, it appears this has been delayed.
The Minister for Health said his Department was "preparing" to undertake a public consultation on this sectoral policy in the "near future" and aims to submit a costed draft policy to Government for its approval later this year.
Emily’s family told the NIRP that they wanted to see changes in the delivery of care for older people not just in the nursing home in question but throughout the country so that no resident or family would go through the horrific experiences they and their mother had to.
At the centre of all this is Emily, who was treated by a doctor at the nursing home until her death in 2021. She was described as having a great personality - warm, brave, funny and strong - and it is for this, she will be remembered most. If you have been affected by any of the issues raised in this article, you can contact Dignity4Patients, whose helpline is open Monday to Thursday 10am to 4pm.