Integrating Irish health care: How can we use the United Nations Convention on the Rights of Persons with Disabilities and Nine Pillars of Integrated Care?

Abstract

Introduction: Over 1 billion (15%) of the world’s population are estimated to experience some form of disability, of whom up to 190 million people live with significant difficulties in functioning, often requiring health care services.
 Despite a myriad of policies and research, disabled people globally continue to be denied their human rights and face enduring barriers to full participation in society.
 The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) is an International Treaty setting out legal obligations on States to promote and protect the rights of persons with disabilities. It provides a unique opportunity to improve the quality of life of all disabled people. The convention identifies that disability arises as a result of barriers in society, including negative attitudes, inappropriate or inaccessible services that result in discrimination against persons with disabilities. The convention includes persons who are or will require Integrated Care. A number of the fifty Articles of the Convention are relevant as a framework to guide the implementation of Integrated Care for and with persons with disabilities. The aim of this workshop was to seek to understand how UNCRPD articles and the IFIC 9 pillars might inform priorities for integrated care.
 Methods: Led and co-designed by people with disabilities, a workshop was held to seek to understand from a broad audience how to use the UNCRPD to frame integrated health care in Ireland in parallel with the IFIC 9 pillars of integrated care.
 The workshop used a World Café methodology, a participatory multi-stakeholder action research process that takes place in a cafe style setting and supports the development of collective knowledge among individuals and communities to address shared problems.
 Participants were allocated into four groups to discuss the following four questions under the guidance of facilitators -
 1.In the context of the UNCRPD and the IFIC 9 pillars of integrated care what are the top 3 priorities to be addressed for people with disabilities across Ireland?
 2.What is currently happening in advancing integrated care for people with disabilities in Ireland?
 3.What would a successful, innovative integrated care system for people with disabilities in Ireland look like?
 4.What are the top 3 solutions you would like to see and work to see implemented immediately?
 Feedback and perspectives were captured on post-it notes and flipcharts and subsequently collated by facilitators. Data were reviewed, and a thematic analysis was conducted.
 Results: There were 20 participants from diverse backgrounds, including experts by experience, disabled persons organisations, academia and health services. Four key themes were generated through inductive thematic analysis: 1) the importance of co-production, 2) the need for equity as opposed to equality, 3) the need for data collection, sharing and knowledge mobilisation and 4) the need for a socioecological integrated care system for people with disabilities.
 Conclusions: Having policies and conventions, and models for the rights of persons with disabilities is not sufficient to ensure implementation. Successful implementation of integrated care needs enablers, including co-production of initiatives with persons with disabilities.