Gebrekkige indicatiestelling en samenwerking bedreiging voor ...

Gebrekkige indicatiestelling en samenwerking bedreiging voor kwaliteit van zorg voor licht verstandelijk
gehandicapten | november 2010
10 Summary
Further to its Strategy Plan 2008-2011, the Health Care Inspectorate is devoting
greater attention to the needs of vulnerable groups in society. One such group is
that of adults with a minor mental disability, given their limited intellectual
functioning and adaptive ability. It is estimated that there are some 36,500 persons
in this category in the Netherlands. The trend whereby persons with a (minor)
mental limitation receive care in the community, living in independent
accommodation rather than a health care institution, demands that the assistance
provided to this target group must be organized differently. All aspects of daily life
(work, household management, leisure time, etc.) are brought into the ambulant
care setting. This results in a complex network of organizations, each providing
support and guidance in one specific area. The quality of this network does much to
determine the quality of care itself, as well as the safety and security of the
patient’s everyday setting.
The Inspectorate decided to conduct the current study because the existing set of
supervisory instruments for this sector does not offer a satisfactory means of
assessing whether organizations which provide care services to adults with a minor
mental disability do so in a fully responsible manner within the network. By
investigating the risks which may exist, together with means of reducing those
risks, the Inspectorate has made the first move towards the development and
adoption of guidelines and standards for cooperation. The guidelines must now be
elaborated by the field itself.
The study involved desk research, an online survey of 177 providers of care to
adults with a minor mental disability (response rate: 79%), visits to six care
providers, an expert meeting and a working conference attended by representatives
of the field parties. The Inspectorate finds that the ‘indication’ (assessment of
patient requirements) frequently takes too little account of the complex problems of
the adult patient and does not offer an opportunity to devise activities or
interventions which will prevent an escalation of those problems. Too little time and
money is devoted to helping patients in a crisis situation. The Inspectorate further
concludes that cooperation within the network remains underdeveloped and lacks
structure. In many cases, the agreements made are not formally recorded and are
not subject to proper evaluation. It is often unclear which party is responsible for
coordinating the activities of the network partners. Communication is limited to
verbal exchanges during consultation meetings. There is no joint support plan and
no system of shared records. While the staff responsible for ambulant care are
usually well qualified, their medical-somatic knowledge is not sufficient to identify
certain problems which could place the patient at risk. The Inspectorate notes a
general ‘mismatch’ between the knowledge of care providers who deal with this
patient group on an everyday basis and that of more specialist practitioners (with
expertise in psychiatry, addiction care, criminal behaviour, etc.).
All these points represent a real and serious risk to responsible care. The
Inspectorate has therefore offered clear advice to the Minister of Health, Welfare
and Sport recommending that an integrated and appropriate system of assessment
and indication be introduced for this target group. It further recommends that care
providers and local authorities should take action to improve network coordination
and management. The Inspectorate urges care providers to formulate a field norm
for good network care, and to do so at the earliest possible opportunity. The results
achieved will then be subject to further evaluation.
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