1. society
2. welfare
3. healthcare

Issue 1 1 |June 201 5
HIQANews
www.hiqa.ie
Welcome
WelcometothelatestissueofHIQANews.
Sinceourlastissue,theAuthorityhaspublishedthePortlaoiseHospitalinvestigationreport,whosefindingsshowtheimportanceofalwaysputtingpatientsfirst,actingwhenawareof
risks,andlearningfromwhenthingsgowrong.
Ourinvestigationwasinitiatedfollowingverynegativeexperiencesofanumberofpatientsandtheirfamiliesattendingthehospital.Theircarefellwellbelowthestandardexpectedina
modernacutehospital.
OurreportoutlinedanumberofseriousfindingswhichhavebeenacceptedbytheMinisterforHealth.Wehavemadeanumberofimportantrecommendationsandlookforwardtotheir
speedyimplementation.
Followingourinvestigation,webelievethatitisvitalthatanationalmaternitystrategyisurgentlydevelopedinordertoensurethattheprofileandmodelsofmaternityservicesmeetsthe
needsofwomenacrossthecountry.
Sincewewereestablishedin2007,HIQAhasproducedasubstantialamountofrecommendationsandlearningforpublichospitalsinIrelandthroughourvariousinvestigations,reviews
andregulatorywork.
Thesefindingsandrecommendationsareintendedtobeusedbyallhealthcareservicestoinformandimprovepractice.Wearenowintheprocessofconnectingthese
recommendationswithoverarchingStandardscontainedintheNationalStandardsforSaferBetterHealthcare.
WewillcommunicatethislearningtosupportpublichospitalstoimplementtheseNationalStandards.Inaddition,workingwithpatient,clinicalandprofessionalorganisations,wewill
developdraftstandardsformaternityservicesinIrelandforpublicconsultation.
Meanwhile,ourchildren’sservices,nursinghomeanddisabilitycentreinspectionteamsarevisitingcentresthroughoutIrelandtoensurethatstandardsarebeingmet.Ourcore
objectiveistopromote,wherenecessary,thequalityoflifeandthehumanrightsofvulnerablepeople.
Inotherdevelopments,ourHealthTechnologyAssessmentTeam(HTA)teamiscurrentlyconductingthreeseparateassessmentstoinformdecision-makingwithinthepublichealth
service.Theserelatedtochronicdiseaseself-management,BCGvaccinationprogrammes,andscreeningforatrialfibrillation,allcloselylinkedtothepublishedMinisterialpriorities.
OurHealthInformationteamhasrecentlyconcludedapublicconsultationonGovernanceandManagementStandardsfortheHealthIdentifiersOperator,avitalcomponentofindividual
healthidentifiers.OnceapprovedbyourBoard,thefinalisedstandardswillbepublishedinduecourse.
Inlinewithourbusinessplanobjective,wehavealsocompletedaninternationalreviewofhowothercountriesgatherandusepatientexperienceinformation.Wewillcommence
discussionsforanationalpatientexperiencesurveywiththeDepartmentofHealthandtheHealthServiceExecutive(HSE)inthecomingweeks.
Inothernews,ourHealthcareteamhaspublishednewguidanceonhowweinspecthospitalsforinfectionpreventionandcontrol.HealthcareAssociatedInfectionsarenotaninevitable
consequenceofhealthcare,andallpatientshavetherighttohigh-qualityhealthcareinasafeenvironment.
WearealsointheprocessofdevelopingourCorporatePlan2016-2019,andwewillbeconsultingwithourstakeholdersandthepublic.TheprojectwillbuilduponourcurrentCorporate
Planfor2013-2015,andweareverykeentohearyourviewsonourfuturestrategicdirection.
Untilthenexttime,verybestwishestoall.
PhelimQuinn,ChiefExecutive
Pictured(centre)isRachelFlynn,ActingDirectorofHealthInformationwithHIQA,attendingtherecentIPPOSIevent.Seenewsiteminthisissue.
Post-Portlaoise,HIQAaimstohelphospitalsmeetstandards
SincewepublishedthereportofourinvestigationintoMidlandRegionalHospital,Portlaoise,wehavebegunworkonlinkingvariousHIQArecommendationstooverarchingstandardsin
theNationalStandardsforSaferBetterHealthcaretohelppublichospitalsimplementthesestandards.
PicturedatthepublicationofourPortlaoiseHospitalinvestigationreportwereHIQACEOPhelimQuinn;MargaretMurphy,patientadvocateandmemberoftheHIQAInvestigationTeam;
speakingatpodium,MartinTurner.
SincewepublishedthereportofourinvestigationintoMidlandRegionalHospital,Portlaoise,wehavebegunworkonlinkingvariousHIQA
recommendationstooverarchingstandardsintheNationalStandardsforSaferBetterHealthcaretohelppublichospitalsimplementthesestandards.
Overthepasteightyears,wehaveproducedalargenumberofrecommendationsandlearningforpublichospitalsinIrelandthroughourvarious
investigationsandotherregulatorywork.Thesefindingsandrecommendationsareintendedtobeusedbyallhealthcareservicestoinformand
improvepractice.
AnewreportwearepreparingwillcommunicatesomeofthislearningtosupportpublichospitalsinimplementingtheNationalStandardsforSafer
BetterHealthcare.ThisisbeingdonebyconnectingtheserecommendationswithanoverarchingStandardintheNationalStandardsforSaferBetter
Healthcare.
TheseNationalStandardsweremandatedbytheMinisterforHealthandpublishedin2012,anddescribeavisionforhigh-quality,safehealthcare.
OurnewdocumentwillconnectourvariousrecommendationswithanoverarchingNationalStandard,togenerateanawarenessofhowthe
Standardsrelatetoreal-worldcaredelivery.
Meanwhile,inourPortlaoiseHospitalreport,wemadeeightrecommendationstoaddressrisksanddeficiencieslocallyandnationally.Amongour
recommendationsisthecreationofanindependentpatientadvocacyservicetoensurethatpatients’reportedexperiencesarerecorded,listenedto
andlearnedfrom,andreportspublished.
OurChiefExecutivePhelimQuinnsaid,“Thisinvestigationwasinitiatedasaresultofthenegativeexperiencesofpatientsandtheirfamiliesinreceipt
ofservicesinPortlaoiseHospital.Theirexperienceshighlightedsignificantdeficienciesinthedeliveryofperson-centeredcareatthehospital.This
carefellwellbelowthestandardexpectedinamodernacutehospital.Wewouldparticularlyliketopaytributetothepatientsandfamilieswhomade
contactwiththeAuthoritytooutlinetheirexperienceofcarewithinPortlaoise.”
PhelimQuinnemphasisedthatlessonslearnedshouldbesharedbetweenhospitalswithinthenewhospitalgroupsbeingdevelopedaroundthe
country,betweenhospitalgroupsandnationallythroughoutthewiderhealthcaresystem.Headdedthatsettingupthenewhospitalgroupsisacritical
pointinthemodernisationoftheIrishhealthcaresystem.
Heconcluded:“Webelievethatclinicalnetworks,suchasthatplannedforPortlaoiseHospital,havethecapacitytofacilitateacommonsystemof
governance,thecapacityformedical,midwiferyandotherstafftorotatebetweenthetwositesandmoreimportantly,thattherightpatientistreatedin
themostappropriateclinicalenvironment.”
AnExecutiveSummaryandRecommendationsofourreporthasalsobeenpublished.
OurChiefExecutivePhelimQuinn
OireachtasCommitteediscussesPortlaoisereport
OurChiefExecutivePhelimQuinnandourDirectorofRegulationMaryDunnionattendedtheOireachtasJointCommitteeonHealthandChildrentodiscussourPortlaoiseHospital
investigationreport,whichattractedconsiderablefeedbackfrommembersoftheOireachtasinattendance.
OurChiefExecutivePhelimQuinnandourDirectorofRegulationMaryDunnionattendedtheOireachtasJointCommitteeonHealthandChildrento
discussourPortlaoiseHospitalinvestigationreport,whichattractedconsiderablefeedbackfrommembersoftheOireachtasinattendance.
PhelimQuinntoldthemeeting:“Iwouldliketoacknowledgethecourageandfortitudeofthemanypatientsandfamilieswhomadecontactwiththe
AuthoritytooutlinetheirexperienceofcarewithinPortlaoiseHospital.Itshouldbeacknowledgedthattheirefforts,harnessedwiththerequiredactions
ofthosechargedwithdeliveringservices,shouldensureabetterexperienceforthoseavailingofservicesatPortlaoiseHospitalinthefuture.”
OurinvestigationfollowedanRTÉInvestigationsUnitPrimeTimeprogrammeonthetragicdeathsofnewbornbabiesinPortlaoiseHospitalanda
laterreportbytheChiefMedicalOfficeroftheDepartmentofHealth.CommitteemembersandotherOireachtasmemberswhojoinedthemeeting
AttheOireachtasmeetingwere
MartyWhelan,PhelimQuinn,and
madeanumberofcontributions.
CommitteeChairpersonJerryButtimerTDofFineGaelsaid:“Itisveryclearinthereport,frommyownreadingofit,thatwedidknowwhoknewwhat
wasgoingon.Ifthereisnoaccountability,wearejustprovidingwindow-dressingandplayingalongwiththesystem...Itisimportantthatwework
collectivelytoresolvetheseissuestoensurepatientsafetyisofparamountimportance.”
MartyWhelan,PhelimQuinn,and
MaryDunnionfromHIQA.Image:
HousesoftheOireachtas
BillyKelleherTDofFiannaFáiltoldthemeeting:“Thereportisdamning.Wecannotassessitanyotherway.Itcallsintoquestionaccountabilityandcommitmentsintermsofbasic
governanceandpatientsafety,notonlyinthecontextofmaternityservicesbutrightacrossthespectrumofservicesprovidedatthehospital.”
Addressingthemeeting,CaoimhghínÓCaoláinTDofSinnFéinsaid:“Therecommendationscontainedinthereportarenotmadelightly.Theyareaprofessionalassessmentof
deficienciesandneedswithinourhealthsystem,beitacutehospitalsettingsorothersettingsacrossthehealthcaresector.”
LucindaCreightonTD,LeaderofRenua,expressedconcernabouttheimplementationofourrecommendations,andadded:“Toechothesentimentsofpreviousspeakers,onealmost
experiencesasenseofdéjàvuwhenreadingthereportbecausemuchofitrepeatswhatwehaveheardpreviously.”
FineGaelTDReginaDohertyalsotoldthemeeting,“Thefirstrecommendationisprobablytheweightiest,notwithstandingalloftheotherdeficiencies.TheAuthoritytalksabout
immediatelysettingup,betweennowandnextMay,anindependentpatientadvocacyservice.”
SenatorColmBurkeposedanumberofquestions,includingabouttheprocessofappointingadministrativestaff,thenumberofmaternityunitsthatdonothaveadirectorofmidwifery,
requestsforadditionalstaffingandHSEoversightofthehospital.HealsoaskedwhatmechanismwasinplacetoensuretheHIQArecommendationswouldbeimplemented.
IndependentTDSeamusHealyaskedaboutthereportdraftingprocess,andtheimpactofbudgetreductionsonpatientsafety.“Thereportisshockingandinreadingitonefeelsallsorts
ofemotion,fromsadnessanddisappointmenttofrustrationandanger.Failureanddysfunctionoccurredatmanylevels,”hetoldthemeeting.
DeputyMaryMitchellO'ConnoraskedaboutthesafetyofmaternityservicesinPortlaoiseHospitalandelsewhere,volumesofcriticalcareactivityintheintensivecareunitofthehospital,
andmanagementoversight,andsaid,“whereelsedoesamotherhavetogotoriskherbaby'shealthandtoriskherownlifebeforeHIQAiscalledin?”
DeputySeanFlemingofFiannaFáilaskedaboutthesafetyofservicesandphysicalinfrastructureatthehospital,thememorandumofunderstandingbetweenitandtheCoombe
WomenandInfantsHospitalinDublin,managementofmedicalnegligence,theroleofHIQAandPortlaoiseHospital,andmanagementaccountability.“Lessonsshouldhavebeen
learned,”hesaid.
SenatorJohnCrownraisedconcernaboutmedicalstaffinglevelsinIrelandandcommented,“wasthereeveracountrythatfounditselfsomuchintheglareoftheinternationalspotlight
fordeficienciesinitsobstetricservicesasthiscountry…Tothinkthatwearestillscratchingourheadsandtryingtoworkouthowtogettheadministrationinplaceisverydepressing.”
OurChiefExecutivePhelimQuinnrespondedtoquestions,andstressedtheimportanceofhavinginplaceaproactiveprogrammeofmonitoringservicesagainststandards.Hesaidthat
HIQAbelievessuchanapproachnotonlyobtainsinformationfromourhealthcaresystem,buthasabetterchanceofdrivingimprovement,ratherthanreactingtocrises.
Alsorespondingtoquestions,ourDirectorofRegulationMaryDunnionsaidweseeanurgentneedforamaternitystrategytodeterminethetypeofmaternityservicesbeingdeliveredin
hospitals.Shesaidtheinfrastructureandsupportstructuresofanyhospitalwilldictatethetypeofservicethatshouldbethere.“Weseethatasacriticallyimportantcomponent,”Mary
Dunniontoldthemeeting.
NewCorporatePlanbeingdeveloped
Overthecomingmonths,wewillstartdevelopingournextcorporateplantoprovideastrategicdirectionfortheAuthorityfortheyears2016to2018.
Overthecomingmonths,wewillstartdevelopingournextcorporateplantoprovideastrategicdirectionfortheAuthorityfortheyears2016to2018.
TheCorporatePlan2016–2018willbeasignificantdocument,asitwilldirectouroverallwork,setoutourvisionandprinciplesandwhatwewillneedtoachievethem.
Indevelopingtheplan,wewillbetakingarangeoffactorsintoaccountincludingGovernmentpriorities,changesinthestructuresofhealthandsocialcareprovision,neworproposed
legislation,theviewsofthepublic,serviceusersandservices.
TheprojectwillfurtherbuilduponourcurrentCorporatePlanfor2013–2015andwillaimtoreviewandrefreshourcurrentstrategy.
Aspartofthisprocess,theAuthoritywillintheautumnlaunchapublicconsultationonthedraftcorporateplantoseekyourfeedbackonthefuturedirectionoftheAuthority.Wewould
encourageyoutocontributetoourstrategicdirection.
Inthemeantime,ifyouhaveanyquestionsabouttheprocess,[email protected].
Healthinformationgovernance
OurpublicconsultationontheDraftinformationgovernanceandmanagementstandardsforthehealthidentifiersoperatorhasbeencompleted.
OurpublicconsultationontheDraftinformationgovernanceandmanagementstandardsforthehealthidentifiersoperatorhasbeencompleted.
TheprojectwilllaythefoundationfortheintroductionofindividualhealthidentifierstotheIrishhealthcaresystem.Individualhealthidentifiersarelifetimenontransferablenumbersthatuniquelyidentifieseachpersonthathasused,isusingormayuseahealthorsocialcareserviceinIreland.
Commentingontheoutcomeofthepublicconsultation,HIQA’sActingDirectorofHealthInformationRachelFlynnsaid:“TheAuthorityreceivedover70responses
fromallacrossthehealthandsocialcaresector.Qualityfeedbackwasreceivedandthedraftstandardswerewellreceived.
“AnadvisorygroupmeetingtookplaceattheendofMayandafinalisedversionofthestandardsisnowbeingprepared.Astatementofoutcomesdocumentin
relationtothefindingsfromthepublicconsultationwillbepublishedinduecourse.”Thedraftstandardsareavailableonwww.hiqa.ie.
RachelFlynn,our
ActingDirectorof
HealthInformation
Newguidetohygieneinspectionsinhospitals
WehavepublishedarevisedguidetounannouncedinspectionsundertakentomonitorcomplianceagainsttheNationalStandardsforthePreventionandControlofHealthcare
AssociatedInfections.
WehavepublishedarevisedguidetounannouncedinspectionsundertakentomonitorcomplianceagainsttheNationalStandardsforthePreventionandControl
ofHealthcareAssociatedInfections.
Thisguidefocusesontheimportantelementsofthe2015monitoringprogrammeandreplacestheguideissuedinMarch2014.
InMay2009,HIQAproducedtheNationalStandardsforthePreventionandControlofHealthcareAssociatedInfectionstoreduceriskandimprovepatientsafety.
Themonitoringprogrammeduring2015willpredominantlyfocusonthefollowingthreeareas:
1. Handhygienecompliance.
2. Cleanlinessoftheenvironmentandequipment.
3. Effectivenessinimplementationandmonitoringofinfectionpreventioncarebundles.
HIQA’sDirectorofRegulation,MaryDunnion,said:“HIQAwillcontinuetomonitorthecleanlinessofthehospitalenvironmentandtheeffectivenessofthe
measurestopromotehandhygieneperformanceasbefore.Inaddition,theAuthority’sunannouncedinspectionswillnowmonitorhospitals’effectivenessin
implementinginfectionpreventioncarebundles.”
Carebundles,whichareastructuredcollectionofevidence-basedmeasures,canreducethechancesofinfectionoccurringfromanumberofhealthcare
interventionswhenusedreliablyandconsistently.Infectioncarebundleshavebeenrecommendedinnationalguidelinestoreducetheriskofinfectionthatmight
occurinpatientswhohaveanintravenousline(dripline)orwhohaveaurinarycatheterinplacetoaidintheiroveralltreatment.
MaryDunnionadded,“HealthcareAssociatedInfectionsarenotaninevitableconsequenceofhealthcare.Everypatienthastherighttohigh-qualityhealthcareina
safeenvironment.Ourinspectionswillassesseachhospitaltoseethattherecommendationsinthenationalguidelinesaremetinordertoreducetheriskof
infectionforpatients.Eachhospitalisresponsiblefordevelopingaqualityimprovementresponsetoidentifyandaddressimprovementswherethereisanoncompliance.”
OurDirectorof
Regulation,Mary
Dunnion
ThefindingsofinspectionswillbemadepubliclyavailableandpublishedontheAuthority’swebsite,www.hiqa.ie.
Childprotectionindirectprovision
WehavepublishedareportonourinspectionofthechildprotectionandwelfareservicesprovidedtochildrenlivingindirectprovisionaccommodationinfouroftheChildandFamily
Agency'sserviceareas,namelyLouth/Meath,Midlands,Sligo/Leitrim/WestCavanandDublinNorthCity.
Wehavepublishedareportonourinspectionofthechildprotectionandwelfareservicesprovidedtochildrenlivingindirectprovisionaccommodation
infouroftheChildandFamilyAgency'sserviceareas,namelyLouth/Meath,Midlands,Sligo/Leitrim/WestCavanandDublinNorthCity.
ThisisthefirstsuchHIQAinspectionofchildprotectionandwelfareservicesindirectprovision.MaryDunnion,ourDirectorofRegulation,saidwe
havegraveconcernsaboutthehighnumbersofchildrenlivingindirectprovisionwhohavebeenreferredtotheChildandFamilyAgency(Tusla).
Ouranalysisshowedthatapproximately14%ofchildrenlivingindirectprovisionwerereferredtotheAgencyinoneyear,whichisasignificantly
higherreferralratethanforthegeneralchildpopulationof1.6%.
Therewereapproximately1,600childrenlivingindirectprovisionaccommodationinIreland,andofthesechildren,therewere209referralsofchild
protectionandwelfareconcernsrelatingto229childrenbetweenAugust2013andAugust2014.
Ofthesereferrals,51%refertochildwelfareissueswhileafurther49%refertochildprotectionconcerns.
Insomeareas,thereweresignificantdelaysinsocialworkinterventions.
Inspectorsfoundthatonoccasion,theReceptionandIntegrationAgency(RIA)movedfamiliesforsafetyreasonsbutgapsincommunicationbetween
theprovidersandtheChildandFamilyAgencyatlocallevelmeantthatthisinformationwasnotalwayspassedon.Asaresult,somesocialwork
interventionsweredelayedordidnothappenandpotentiallyplacedchildrenatrisk.
Tosupportthesechildrenandfamilies,manystaffprovidedexcellentchild-centredservices,advocatingforchildrenandmeetingtheirneedsthrough
timelyandeffectiveinterventions,includingseekingrespitefostercareforchildren,providinghigh-qualityfamilysupport,andensuringchildrenweresafethroughhomevisitsandby
listeningcarefullytochildrenabouttheirlives.
HIQAhasmadefourrecommendationstotheChildandFamilyAgency:
1. Developaninter-culturalstrategytoinformtheprovisionofsocialservicestoethnicminoritychildrenandfamilies.
2. Completeanaudittoensuretherearenochildrenatriskofharmbecauseofoutstandingorincompleteassessmentsduetothemovementoffamiliesbetweenaccommodation
centres.
3. Ensureeffectiveinteragencyandinter-professionalcooperationwithkeystakeholderstoensuredecisionsconsiderthebestinterestsofchildren.
4. Gatherinformationonreferralstoitsservicesaboutchildrenindirectprovisionaccommodationtoinformstrategicplanning.
HTAofBCGvaccinationprogrammes
HIQAwillinthenearfuturebeginapublicconsultationonahealthtechnologyassessmentweareconductingofBCGvaccinationprogrammes.
HIQAwillinthenearfuturebeginapublicconsultationonahealthtechnologyassessmentweareconductingofBCGvaccinationprogrammes.
Sincethe1950s,theBCG(BacilleCalmetteGuerin)vaccinehasbeenroutinelygivenaspartoftheroutinechildhoodvaccinationscheduleinIreland
toreducetheriskofcontractingtuberculosis(TB).
PoliciesonBCGvaccinationdifferbothregionallywithinIrelandandinternationally.IncountrieswithalowincidenceofTB,oftenonlythoseathighrisk
arevaccinated.High-riskgroupstypicallyincludehealthcareworkersandinfantswhoseparentsarefromacountrywithhighTBincidence.
AnumberofEuropeancountriesandregionsthatpreviouslyhaduniversalvaccinationprogrammes(whereallchildrenarevaccinated),includingthe
UK,France,GermanyandSpain,haveswitchedtoprogrammesofselectivevaccinationforhigh-riskgroups.
IrelandisconsideredacountrywithalowincidenceofTBandthereforemaybesuitableforselectiveratherthanuniversalvaccination.Theuseof
selectivevaccinationreducesunnecessaryvaccinationandthenumbersofadversereactions.
However,apolicyofselectivevaccinationwillalsoresultinsomecasesofTBthatwouldhavebeenpreventedbyuniversalvaccination.HIQAisnow
conductingahealthtechnologyassessmentofBCGvaccinationprogrammes.
HIQA' sDirectorofHealth
TechnologyAssessmentandour
ActingDeputyCEO,DrMáirínRyan
OurDirectorofHealthTechnologyAssessmentandActingDeputyCEO,DrMáirínRyan,said,“ThisassessmentisaimedatbuildingonpreviousworkcarriedoutbytheNationalCentre
forPharmacoeconomics(NCPE)andtheNationalImmunisationAdvisoryCommittee(NIAC)todeterminethepotentialimpactofmovingfromuniversaltoselectiveBCGvaccinationin
Ireland.Theassessmentwillconsiderclinical,economic,ethical,societalandorganisationalissues.ThisHTAisduetobeputoutforpublicconsultationinJuly2015.”
Residentialservicesforpeoplewithdisabilities
Oneofourbiggestprogrammesofworkisregulatingdesignatedcentresforadultsandchildrenwithadisability,andensuringthatresidents’humanrightsareprotectedandpromoted.
Oneofourbiggestprogrammesofworkisregulatingdesignatedcentresforadultsandchildrenwithadisability,andensuringthatresidents’humanrightsare
protectedandpromoted.
ThiswasasectorthathadnotpreviouslybeenregulatedwhenweassumedthisfunctioninNovember2013.
Wetookresponsibilityforregisteringnearly1,000designatedcentresofvaryingsizesacrossthecountry.Atthesametimeandinparallel,wecontinuedto
receiveandrespondtoriskwithincentres.
RecentlyaddressingtheAnnualDelegateConferenceoftheIrishNursesandMidwivesOrganisation,ourChiefExecutive,PhelimQuinn,said:“Wehaveseen
andassessedexcellentexamplesofprogressiveservicesthatprovidersandtheprofessionalstaffworkingwithinthoseservicesshouldbeproudof.”
Headdedthatinthemain,servicesthatwehaveassessedasbeingsignificantlycompliantwiththerelevantrequirementshavealsoembracedthevisionset
outintheHealthServiceExecutive’s2011report,MovingonfromCongregatedSettings,aStrategyforCommunityInclusion.
Atthisstagewehavenowregisteredover100compliantservices.However,hesaidourrecentinspectionfindingsacrossdifferentproviderorganisationshavehighlightedanumberof
fundamentalbreachesofregulationsandstandardsandinsomeinstancesinthehumanrightsofindividuals.
PhelimQuinnstated:“TheymostdefinitelyruncontrarytotheUNconventionontherightsofpeoplewithadisability.Theseexamplesexistinservicesprovidedinthepublic,voluntary
andprivatesectors.”SpeakinginAprilattheNationalDisabilitySummit,PhelimsaidweneedtoensurethatwesharethecollectivegoalofmakingIrelandanexemplarnationinthe
promotionofrightsandinitscareandsupportofpeoplewithdisabilities.
Children’steamupdate
Throughoutthepastthreeyears,ourChildren’sTeamhasassumedresponsibilityfortheregulationofanincreasingnumberanddiversityofchildren’ssocialservices.
Throughoutthepastthreeyears,ourChildren’sTeamhasassumedresponsibilityfortheregulationofanincreasingnumberanddiversityofchildren’ssocialservices.
Inthemain,theseservicesareprovidedbytheChildandFamilyAgency(Tusla).
During2015,wewillengageinnewapproachestothemonitoringandoversightofsomeoftheseservicesbasedonthefactthattheyareprovidedbyasinglenationalproviderwitha
singlegovernancestructure.
Thisapproachwilluseexternalexpertiseintheassessmentoftheagency’sgovernancesystemsintheprovisionofchildprotectionandwelfarestandards.Thisreviewwillbeinaddition
toourinspectionsofarangeofotherchildren’sservices.
Patients’healthcareexperiences
Whileweaimtoremainresponsivetosignificantriskandservicefailureinthehealthcaresystem,ourplannedprogrammefor2015willbebasedonourdesiretotesthowNational
Standardspublishedin2012havetranslatedintobettercareforpatientsandotherserviceusersinourhealthcaresystem.
Whileweaimtoremainresponsivetosignificantriskandservicefailureinthehealthcaresystem,ourplannedprogrammefor2015willbebasedon
ourdesiretotesthowNationalStandardspublishedin2012havetranslatedintobettercareforpatientsandotherserviceusersinourhealthcare
system.
Theprogrammeapproachisaimedatsharingadvanceknowledgewithprovidersofthesortsofassessmentswewishtoundertakeinthecoming
years.Therefore,ourprogrammefor2015willincludethedevelopmentofnewapproachesintheassessmentofpatientexperiencesofhealthcare
services.
Commentingonthedevelopment,ourChiefExecutivePhelimQuinn,said:“Inthisventurewehopetoworkcollaborativelywithserviceprovidersand
theDepartmentofHealthinthedevelopmentanddeliveryofacomprehensivepatientexperiencesurvey.Webelievethatapartnershipapproachinthe
areaofpatientexperiencesurveysisvitalandissupportedbyapproachestakeninternationally.
“In2013,theFrancisreportintofailingsintheMidStaffordshireHospitalsTrustintheUKhighlightedtherequirementforprovidersandregulatorstoattendtowhatserviceuserswere
sayingaboutthequalityandsafetyofservices.Hehighlightedthatinadditiontothecomplexrangeofdataandinformationproducedbyhealthcaresystems,patients’experiencewasa
keyindicatorofhowserviceswereperforminginrespecttoqualityandsafety.Moreparticularly,hesaidthatpatientexperiencedataappearedtobeakeyindicatorofwhenthingswere
goingwrongwithinservices.”
HIQAworkingonpatientsafetysurveillance
Wehavecompletedaninternationalreviewonpatientsafetysurveillancesystems,followingarecommendationmadebytheChiefMedicalOfficeroftheDepartmentofHealthinhis
report,HSEMidlandRegionalHospital,PortlaoisePerinatalDeaths(2006-date).
Wehavecompletedaninternationalreviewonpatientsafetysurveillancesystems,followingarecommendationmadebytheChiefMedicalOfficeroftheDepartmentofHealthinhis
report,HSEMidlandRegionalHospital,PortlaoisePerinatalDeaths(2006-date).
Thisentailedareviewofimportantliteraturealreadypublishedinrelationtopatientsafetysurveillancesystemsandanin-depthreviewoffourregionsandcountries,namelyBritish
Columbia,Denmark,EnglandandScotland.
HIQA’sActingDirectorofHealthInformationRachelFlynnsaid:“Thisprovideduswithadetailedunderstandingofthenational,provincialandregionaladverseeventreportingsystems
inplacethatcanbeusedforlearning,improvementandtriggeringactionwherepatientsafetyisatrisk.
“Aswellasthereportingandlearningsystemsthemselves,wealsoparticularlyfocusedonthecoordinationofpatientsafetyintelligenceintheindividualcountries.Thisreviewwillbe
publishedlaterthisyear.”
Meanwhile,an‘asis’analysisbyHIQAofthesituationinIrelandinrelationtopatientsafetysurveillanceisalsocurrentlyunderway.Wewillbeconveninganadvisorygrouplaterinthe
yeartohelpdeveloprecommendationsonthecoordinationofpatientsafetysurveillanceinIreland.
Newguidanceforbudgetimpactanalysis
WearepreparingtopublishguidanceonbudgetimpactanalysisofhealthtechnologiesinIreland.
WearepreparingtopublishguidanceonbudgetimpactanalysisofhealthtechnologiesinIreland.
Thiswillprovideanoverviewoftheprinciplesandmethodsthatareusedinassessinghealthtechnologies,andwillpromotetheproductionofhigh-qualityassessmentsthatare
consistentandrelevanttotheneedsofdecisionmakersandkeystakeholdersinIreland.
OurguidanceonbudgetimpactanalysisofhealthtechnologiesinIrelanddocumentsupportsourpreviouslypublishedGuidelinesfortheBudgetImpactAnalysisofHealthTechnologies
inIrelandbyprovidingmoredetailedadviceandexamplestoaidthoseconductingsuchananalysis.
Itisdesignedtosupportclinicalguidelinedevelopers,HealthServiceExecutive(HSE)staffandanyoneelsecarryingouthealthtechnologyassessmentsconductedby,oronbehalfof,
HIQA,theNationalCentreforPharmacoeconomics,theDepartmentofHealthandtheHSE,includinghealthtechnologysupplierspreparingapplicationsforreimbursement.This
guidancedocumentisduetobepublishedshortly.
EuropeanNetworkofHTAAgencies
Picturedisadelegationfrom22countriesoftheEuropeanNetworkofHTAAgencies,ofwhichHIQAisamember,whorecentlyheldameetinginourDublinoffice.
HIQAreviewingchronicdiseaseself-management
Chronicdiseases(ongoingconditionsthatcanbecontrolledandmanagedbutnotcured)arereportedasbeingtheleadingcauseofmortalityintheworld,representing60%ofalldeaths
worldwideand88%ofalldeathsinIrelandin2014.
Chronicdiseases(ongoingconditionsthatcanbecontrolledandmanagedbutnotcured)arereportedasbeingtheleadingcauseofmortalityintheworld,representing60%ofalldeaths
worldwideand88%ofalldeathsinIrelandin2014.
Self-management-supportinterventionsareanystepsthathelppeopletotakecontrolandmanageportionsoftheirchronicdiseaseordiseasesthrougheducation,trainingandsupport.
Theymaybeaworthwhileadditiontobestmedicalcare.
Formalself-managementsupportinIrelandiscurrentlyprovidedthroughanumberofdifferentavenues.However,atpresentthereisuncertaintyregardingthebenefitsofselfmanagement-supportinterventionsintheshortandlongterm.
OurHealthTechnologyAssessment(HTA)teamisconductinganassessmentofformalself-managementsupport.ThepurposeofourHTAisfirstlytoevaluatetheclinicalandcosteffectivenessofchronicdiseaseself-management-supportinterventions.
Theassessmentwillalsoconsiderresourceandcostingimplicationsaswellasthewiderimplicationsthatimplementingchronicdiseaseself-management-supportinterventionsmay
haveforpatients,thegeneralpublic,orthehealthcaresystem.
Privacyanddignityofnursinghomeresidents
Wearecontinuingourworkintheregulationofdesignatednursinghomeswiththeobjectiveofpromotingqualityoflifeforpeoplelivingthere,andprotectingandpromotingtheirprivacy
anddignity.
Wearecontinuingourworkintheregulationofdesignatednursinghomeswiththeobjectiveofpromotingqualityoflifeforpeoplelivingthere,and
protectingandpromotingtheirprivacyanddignity.
Thisyear,wehavethechallengingtargetof250centrestore-register,andarecommittedtoensuringthatwecontinuetopromotegoodpracticein
nursinghomesthroughourthematicinspections.
Meanwhile,thephysicalenvironmentinresidentialcentreswhereolderpeopleliveisakeycomponentofhigh-qualitycareanddemonstratesthe
regardthatwehaveforthepersonbeingcaredfor.
Whenwestartedregulatingnursinghomesin2009,itwasrecognisedthatthephysicalenvironmentinasubstantialamountofdesignatednursing
homesdidnotaffordthebestpossiblelevelsofprivacyanddignitytoresidents.
Providerswereadvisedthatcompliancewiththerelevantrequirementsinthisareawouldbeneededby1July2015.Aregulatorynoticeissuedtothe
sectorinMarch2013reiteratedthisrequirementandtheJuly2015timeline.
JohnFarrelly,HeadofOlderPersons’ProgrammeinHIQA,stated:“In2014,wecontinuedtofocusontheadequacyofthephysicalenvironmentfor
inspectionandimprovement.Thisapproachwillcontinuein2015.”
RegistrationapplicationswillberenewedforthenumberofbedsappliedforifthepremisesaresuitableandoriftheAuthorityhasacceptedacosted,fundedplanwithatimelinethat
clearlysetsouthowcompliancewithphysicalenvironmentrequirementswillbeachieved.
Meanwhile,werecentlyreceivedapresentationonmulticulturalismfromAgeActionIreland,whichsayscarehomesareattheforefrontofanewmulticulturalanddiverseIreland,as
manycarehomestaffcomefrommigrantorminorityethnicbackgrounds.
JohnFarrellysaidresearchhasconcludedthatweneedtobeginopeningupconversationstoensurethatallstaffaresupportedandrecognisedwithinthecontextofmulticulturismand
diversity.
HTAofscreeningforatrialfibrillation
Wearefinalisingahealthtechnologyassessment(HTA)ofascreeningprogrammeforatrialfibrillation,aconditioninwhichaperson'sheartbeatsinanirregularrhythm(arrhythmia).
Wearefinalisingahealthtechnologyassessment(HTA)ofascreeningprogrammeforatrialfibrillation,aconditioninwhichaperson'sheartbeatsinanirregularrhythm(arrhythmia).
Atrialfibrillationisthemostcommonarrhythmiaseeningeneralpracticeandisassociatedwithafive-foldincreaseintheriskofstroke.
Strokesrelatedtoatrialfibrillationarealsomoresevere,withtwicethedeathrateofnon-atrial-fibrillation-relatedstrokesandgreaterfunctionaldeficienciesforthosewhodosurvive.
Irishdatasuggeststhatalmost40%ofindividualswithatrialfibrillationareunawarethattheyhaveanirregularheartrhythm.
TheNationalCardiovascularHealthPolicy2010–2019recommendedthatascreeningprogrammeforatrialfibrillationshouldbeestablishedforpeopleaged65andover,following
formalevaluationtoensureaneffectivemeansofimplementation.
TheHealthServiceExecutive(HSE)NationalClinicalProgrammeforStrokerecentlyconductedapilotprojectinalimitednumberofareas,toassessthefeasibilityofanational
screeningprogramme.
TheAuthorityisundertakingahealthtechnologyassessment(HTA)ofscreeningforatrialfibrillationtoexaminetheclinicalandcost-effectivenessofthisinterventionaswellasthe
budgetimpactandresourceimplicationsofanationalscreeningprogrammeinIreland.OurHTAisduetobecompletedinthenearfuture.
2014AnnualReportandworkplanfor2015
WehavepublishedourAnnualReportfor2014,whichprovidesanoverviewoftheworkundertakenbytheAuthoritylastyear.
WehavepublishedourAnnualReportfor2014,whichprovidesanoverviewoftheworkundertakenbytheAuthoritylastyear.
Meanwhile,arangeofadditionalfunctionsaretobeassignedtoHIQAunderGovernmentpolicyinthecomingyears.
PhelimQuinn,ourChiefExecutive,saysthisplannedprogrammewillbeachallengingoneforusasarelativelysmallorganisation.
“Iwouldalsoacknowledgethatthesechangeshaveanimpactonserviceprovidersandstaffwhowillneedtoattendtothedemandsofregulationand
oradherencetostandards,guidelinesandhealthtechnologyassessments,”headded.
Keyamongthosechangeswillbe:
arevisedHealthAct,markinganextensionofHIQA’smonitoringpowersintotheacuteprivatehealthcaresector
eventualtransitiontoaprogrammeoflicensingforpublicandprivatehealthcareservices
responsibilityfortheoversightofionisingradiationpatientexposureregulations
significantexpansioninourprogrammeofhealthtechnologyassessmentdevelopment
developingstandardstosupporttheintroductionoftheindividualhealthidentifier
developingstandardsinsupportoftheeHealthStrategyandePrescribing
addressingrecentrecommendationsonanationalpatientsafetysurveillancesystem.
Ourplannedprogrammeofworkin2015isaimedatmeetingourcoreobjectivesofensuring:
Careisimproved–wewillenablesustainableimprovementsinsafetyandqualityofhealthandsocialcareservices.
Peoplearesafeguarded–weacttoreducetherisksofharmandabusetopeopleusinghealthandsocialcareservices.
Peopleareinformed–wepubliclyreportonsafety,qualityandeffectivenessofhealthandsocialcareservices.
Policyandservicedecisionsareinformed–weinformpolicydevelopmentandhowservicesaredelivered.
UpdateonHIQA-IHIprogrammereview
WerecentlyheldtwofurthergraduationeventsforpeopleworkinginhealthandsocialcareserviceswhohavesuccessfullycompletedtheHIQA-InstituteforHealthcareImprovement
(IHI)OnlineQualityImprovementProgramme.
Werecentlyheldtwofurthergraduationeventsforpeopleworkinginhealthandsocialcareserviceswhohavesuccessfullycompletedthe
HIQA-InstituteforHealthcareImprovement(IHI)OnlineQualityImprovementProgramme.
In2013,usingalicensingarrangementwiththeUS-basedIHI,weintroducedastructuredlearningprogrammeinqualityimprovementsciencetools
andmethodologies.
Lastyear,awidespectrumofhealthandsocialcarestafftookpart,with138peopleacrossthehealthandsocialcaresectorcompletingthe2014
course.
OurDirectorofSafetyandQualityImprovementMarieKehoe-O’Sullivan,says:"AtourrecentgraduationeventsinDublin,67peopleworkingin
hospitals,thedisabilitysector,patientsafetyrepresentativesandstafffromHIQAallreceivedtheircertificates."
MarieKehoeO' Sullivan,HIQA' ​s
DirectorofSafetyandQuality
Improvement
InternationalNewsRoundUp
WorldConferenceonElderAbuseandWEEAD
OurHeadofOlderPerson’sprogrammeJohnFarrellyspokeatthe10thWorldConferenceonElderAbuseandWEAAD(WorldElderAbuseAwarenessDay)2015Lead-up,whichtook
placeon22AprilinDublin.Theconference–organisedbytheInternationalNetworkforthePreventionofElderAbuse–consideredadvancesinresearchintoelderabuse,and
associatedpracticeandlegislation.TheeventwasopenedbyKathleenLynch,MinisterofStateattheDepartmentofHealth.Theeventalsolookedatraisingawarenessofprotecting
olderpeople,areviewofpracticeincountriesacrossEuropeandtheroleofregulationinsafeguardingolderpersons.
IPPOSIHealthInformationRoundT ablemeeting
TheIrishPlatformforPatients’Organisations,ScienceandIndustry’s(IPPOSI)annualHealthInformationRoundTablemeetingwiththeSecretaryGeneraloftheDepartmentofHealth
inrelationtohealthinformationtookplaceinDublinon26May.
Therewasadetaileddiscussioninrelationtothelegislativeframeworkforhealthinformation,boththeforthcomingHealthInformationBillandalsonewforthcomingEuropean
legislationinrelationtodataprotection.
MembersofourHealthInformationteamattended,includingourActingDirectorofHealthInformationRachelFlynn,whospokeattheeventabouttheimportanceofhavinganational
strategicframeworkinplacefornationalhealthandsocialcaredatacollections.
JimBreslin,SecretaryGeneraloftheDepartment,gaveakeynotepresentation.OtherpresentersincludedRichardCorbridge,theChiefInformationOfficeroftheHealthService
Executive(HSE)andGarrettO’NeillfromtheOfficeoftheDataProtectionCommissioner.
EUnetHT APlenaryAssembly
HIQA'sDirectorofHTAandourActingDeputyCEODrMáirínRyan(secondfromleft)wasamongthosewhoattendedtherecentEUnetHTAPlenaryAssemblyinDenmark
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