At recent HMI Regional Meetings in Leitrim and Limerick, Finbarr Colfer discussed the experience of regulation to date and potential learning for health and social care service managers of sectors that are due to be regulated in the future.
At recent Health Management Institute of Ireland Regional Meetings in Leitrim and Limerick, a representative of the Health Information and Quality Authority (the Authority) discussed the experience of regulation to date and potential learning for health and social care service managers of sectors that are due to be regulated in the future.
The Authority is required to “promote safety and quality in the provision of health and personal social services for the benefit of the health and welfare of the public” (Section 7, the Health Act 2007).
Regulation and inspection are used as a way of ensuring consistent standards of care and of ensuring the safety and wellbeing of service users. The regulation of residential services for older people commenced on July 1, 2009 and plans are in place for commencement of the inspection of child protection services, the regulation of children’s residential services and of residential services for people with a disability.
There are also public debates about the further extension of regulation to other sectors such as home help services and licensing of hospitals. In this context, it may be useful to reflect on the experience of the Authority to date.
A number of factors are used to determine the fitness of the provider and key senior managers
The Health Act 2007 placed HIQA on a statutory footing as an independent body reporting directly to the Minister for Health. The Authority has a national remit, across the private, voluntary and public sectors.
The Act includes the responsibilities of the Authority for registering and inspecting residential centres for children, older people and people with disability. Once registered, centres must apply for renewal of registration every three years. The Authority is also responsible for the inspection of special care units, detention centres and foster care provision. In addition, the Act sets out the responsibilities of providers and the sanctions for providers if they commit an offence under the Act.
A key requirement of the Act is the fitness of the provider and other key senior managers. Section 50 of the Act states that fitness is demonstrated through compliance with the Regulations, the Standards and any other enactments deemed relevant by the Authority.
A number of factors are used to determine the fitness of the provider and key senior managers including:
- Knowledge of the Act, the associated Regulations and the Standards.
- Demonstrating an understanding of contemporary principles of service provision.
- Providing the service in a safe manner.
- Providing sufficiently skilled staff who are supervised appropriately.
- Providing sufficient resources to the centre.
- Ensuring that the service is viable and consistent through adequate governance arrangements.
The Authority evaluates the fitness of providers and key senior managers against the Act, Regulations and Standards. Regulations are developed by the Department of Health, and providers must comply with the Regulations. It is an offence not to comply with them.
The Standards are developed by the Authority. Usually, these are developed by a working group consisting of service users, providers and other experts in the field. They are outcome-based and set out the quality goals that providers must seek to achieve.
Inspectors gather evidence that indicates whether the provider, person in charge and other key senior managers are fit. This is an ongoing process of monitoring and is not limited to inspection. For example, the provider is required to make certain notifications to the Authority immediately and is required to submit quarterly notifications of specified information. If areas of non-compliance are identified on inspection, the provider is required to submit an Action Plan on how the non-compliances will be addressed. The Authority also requires the provider to submit updates on progress on the Action Plan.
The Act also provides the Authority with enforcement powers which are used when there is a significant risk to the health or wellbeing of residents or where there is persistent non-compliance with the Regulations. These powers include the addition of restrictive conditions to the registration, the suspension or removal of registration and/or prosecution.
The focus of the Authority’s work is to promote the safety, wellbeing and quality of life of service users. The role of the Authority is to monitor and inspect centres, make judgments on whether there is compliance with the Act and the Regulations, and on the implementation of the Standards. These findings are included in the inspection reports and are published on the Authority’s website.
The experience to date is that when providers have a good knowledge of their legal responsibilities, of the Standards and of contemporary best practice, there is ongoing improvement in the overall quality of care and quality of life of service users, and the inspection and regulation process can be managed in a much more efficient manner.