Stronger protection measures required

While the regulation of specific aspects of care was beginning to sustainably improve services in social care services and hospitals, some nursing homes, residential centres for people with disabilities and foster care services must take stronger measures to protect vulnerable people in their care against abuse, harm and exploitation, according to a review of the regulation of health and social care by HIQA.

The Overview of 2016 HIQA regulation of social care and healthcare services is the first combined analysis of its kind by HIQA, covering regulation of nursing homes, residential services for people with disabilities and children, and themed inspections of key areas of hospital practice.

The report found much good work in Ireland’s health and social care services.

It also found:

  • A culture of regulation is now embedded in nursing homes and is influencing improvements in hospitals, disability and children’s services
  • There are clear links between good governance of services and better outcomes for people using services
  • Some services must take safeguarding more seriously, particularly having Garda  vetting in place for all staff and volunteers
  • National health and social care policy needs to be developed and followed to support improvement in services which may be locally-driven
  • Those who fund services need to take a greater role in holding those services to account.

Mary Dunnion, Chief Inspector of Social Services and Director of Regulation with HIQA said: “In general, many of the people using services that we spoke with in 2016 were happy with their service and felt that they were receiving good care. Nonetheless, a considerable number of people told us that they were not satisfied, that the services were not person-centred and that services were failing to meet their needs.”

“A consistent theme throughout all of our regulatory activities in 2016 was the critical importance of good governance and management.

“Safeguarding measures enable children and at-risk adults to live free from abuse, neglect, harm and exploitation. In 2016, HIQA encountered services where safeguarding was not sufficiently strong and comprehensive.

“In 2016, some services were still not taking the issue of Garda Síochána vetting sufficiently seriously and were thereby failing in their legal responsibility to safeguard adults and children. In addition, in a range of disability services, we found that leadership and practice in recognising, preventing and protecting people from harm was deficient. HIQA believes safeguarding needs to be further strengthened by introducing new legislation to better protect those who may be at risk.”

HIQA believes providers should be accountable to service users and also to those who fund services.

Said Mary Dunnion: “This is why the concept of commissioning is worthy of further consideration in the Irish context. A well-established practice in other countries, commissioning is a strategic process of identifying a population, community or individual service need; and designing, sourcing and delivering those necessary services.

“The State distributes large sums of funding to various organisations to provide a service on its behalf. However, there is often insufficient oversight of how this money is used or on the outcomes it achieves for service users. HIQA acknowledges the preliminary work done by the Health Service Executive on developing such a framework.”

HIQA believes the absence of a clear plan for the future of the health service continues to impact on the delivery of services and reform is clearly needed in this area.

Mary Dunnion said: “The 2016 overview report shows there is a requirement for clear national policy direction, policy implementation and timely decision-making in terms of health and social care services. This was a key finding in both of the reviews conducted by the healthcare team in 2016 in relation to the country’s ambulance services and the services at Midlands Regional Hospital, Portlaoise.”

In nursing homes and residential centres for people with disabilities, HIQA has powers to enforce compliance with regulations. During 2016, the Chief Inspector issued 11 notices of proposal to refuse the application to register and cancel the current registration status of designated centres for people with disabilities. Throughout 2016, disability service providers were required to attend 153 meetings with the Office of the Chief Inspector to account for their failure to meet their regulatory responsibilities. In older people’s services, a total of 38 nursing homes had restrictive conditions applied to their registration.