End of Year Review: HIQA
Written by Angela Fitzgerald, HIQA, CEO
Engaging and Working with Stakeholders
In 2023, as we emerged from the COVID-19 pandemic, we witnessed unprecedented challenges for those providing care in terms of meeting additional emergency and elective demands. Key drivers included unmet need as a result of the pandemic, coupled with pressures from demographic factors primarily associated with population growth, ageing and movement.
On behalf of the Health Information and Quality Authority, I acknowledge the extraordinary efforts by staff in health and social care settings during the pandemic and beyond to meet the needs of people using services. However, there is no doubt that there has also been a significant impact on staff arising from these sustained efforts in terms of fatigue and overall resilience. In terms of patient and service user experience, it is also important to acknowledge that these combined challenges have also had an impact on those using health and social services in terms of timely access and safe effective care.
HIQA was established in 2007 to drive high-quality and safe care for people using health and social care services in Ireland. Our remit is rapidly expanding and our approach to regulation and inspection has evolved over time. In the 16 years since our establishment, we have gained pace in how we develop standards, inspect and review health and social care services, and support informed decisions on how services are delivered through our work in evidence synthesis and health information. For example, our work in the area of providing evidence synthesis has become increasingly important as Government seeks to address competing demands between new health technologies and treatments.
In our approach to regulation, we have sought to be fair, proportionate and accountable. At the same time, we are very mindful of the imperative for HIQA to continue to be an advocate to ensure that the safety and welfare of all service users is promoted and safeguarded.
There are also a number of important developments happening in the regulatory landscape. Earlier this year, the President signed the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 into law. This will bring new responsibilities for HIQA, including the expansion of our remit into private hospital services, a requirement for all hospitals to report notifiable incidents to HIQA and an extended remit in relation to investigating individual adverse events in nursing homes. This is an important step in supporting the development of an open culture in health and social care services and enabling learning when things go wrong. Also, as many patients move between public and private care settings, this new legislation will provide a common regulatory framework to support standardisation of care.
Over the past year we have also been preparing for other new significant areas of work, namely new functions under the Human Tissue (Transplantation, PostMortem, Anatomical Examination and Public Display) Bill 2022, the monitoring of international protection accommodation services and the regulation of homecare services. The regulation of homecare services will support the safe management of individuals wishing to stay, and age, in their own homes, which we hope will also have an associated positive impact on demand for hospital services. We are working closely with the Department of Health to inform the development of a Health Information Bill, which aims to ensure that Ireland has a fit-for-purpose national health information system. While our remit continues to expand, our vision remains the same; Safer Services and Better Care for All.
A key objective for HIQA in delivering on our vision is to engage and work collaboratively with our stakeholders and use their feedback to inform our approach. These new regulatory roles and functions will require the development of new relationships to deepen our understanding of the operation of both public and private health and social care services. It also offers us an exciting new challenges as a regulator to extend national standards for safer better care to new services. We are committed to supporting health and social care providers to meet their regulatory requirements and will continue to engage with hospitals and other healthcare services in preparation for these new legislative changes. These new areas of work will place additional emphasis on another core value; promoting and protecting human rights. We know that for those who use our services, this is a fundamental principle when accessing healthcare services. We will continue to focus on this into 2024 and beyond, continuing to promote human rights as well as identifying, challenging and reporting on breaches of rights in health and social care services.
As the regulator, it is also important that we are proportionate, fair and accountable in the exercise of our legal responsibilities, and that we advocate for change on behalf of both providers and those using our services, where appropriate.
Our inspection reports are an important tool in both identifying what is working well and where improvements are needed. In 2023, a consistent finding through our inspection activity across both health and social care is the importance of good governance and management. We continue to highlight that well-governed and managed services enable better outcomes for people using them.
Our inspections of emergency departments demonstrate that good operational capability and internal processes enable the efficient functioning of emergency departments to reduce overcrowding, support effective patient flow and ensure safer services for patients. Therefore, we will continue to seek to drive improvements in the quality and safety of care through responsive leadership, operational management and effective governance at local and regional levels. Our inspections also amplify the critical importance of patient safety in healthcare settings, particularly in those settings where emergency care is delivered. We continue to emphasise that the effective identification, monitoring and management of patient safety risks associated with overcrowding in emergency departments is a key area for both immediate and longer-term attention.
A core requirement in addressing patient safety risks is having adequate capacity both in acute and community settings to meet service need in a timely way. Through the publication of our individual hospital and overview reports, we have highlighted the importance of delivering on immediate and medium-term capacity requirements across the healthcare system. We have sought to extend the discussion on capacity to whole-system solutions and responses. Finally, we identified the importance of strategic workforce planning which anticipates and manages temporary and structural staffing shortages as a critical success factor in delivering safe, effective care.
Through this work, we continue to advocate on behalf of patients and the public with the aim of achieving sustained improvement in terms of access, safety and quality. As we move into 2024, we will continue to amplify the key priority investment requirements needed in overall capacity, as well as focusing on improved internal capability required to enable sustained improvements.
The links between residential and acute care are significant, with challenges in one area impacting on another. Throughout 2023, HIQA’s Chief Inspector, who is responsible for the regulation of designated centres including nursing homes, used her regulatory powers to support and influence the delivery of safe and effective services in nursing homes. During the year, we worked collaboratively with the HSE and private nursing homes to support the safe and effective discharge of older people from hospitals to the nursing home of their choice by prioritising the registration of new beds within the sector and by enabling increased planned discharges on a seven day basis. Similarly, the inspection process seeks to promote the principle of maintaining older people’s care and safety within their nursing home where possible and only requiring transfer to hospital when absolutely necessary. In this context, we engaged collaboratively with service providers during the year to ensure that they make the required resources available to ensure that they can deliver the appropriate care for their residents. As Ireland moves towards the establishment of integrated health and social care regions, we are committed to working to ensure that our approach to regulation supports the delivery of integrated care, within and across these settings. Another example of how we work collaboratively is our National Care Experience Programme. This is a powerful collaboration between HIQA, the HSE, the Department of Health, and patient advocacy groups, where we listen and respond to people using services through national surveys. For example, the National Inpatient Experience Survey has provided important feedback on how patients experience hospital services, allowing for improvement opportunities to be identified and actioned at individual hospital and national level.
In March 2023, we launched the National End of Life Survey – the first national survey to ask people who have been bereaved about the end-of-life care provided to their loved ones in the last days and months of their life. The results will be published in 2024, and we hope that our findings will provide valuable information on the standard of care provided at end of life, will show what is working well and highlight areas where improvements are required. Earlier this year, we also published the results of Ireland’s first National Maternity Bereavement Experience Survey, which asked women and their partners about their experiences of maternity bereavement care in an Irish maternity hospital or unit after a pregnancy loss or perinatal death. These surveys aim to help us understand the standard and quality of care so that improvements can be made. To date, all our surveys have found that the vast majority of patients and service users have positive experiences, but there are opportunities for improvement, notably in the areas of communication about their care, having time to talk to professionals about worries and fears and input to decisions about care. We are fully committed to driving change through the findings of these surveys.
I look forward to 2024 and the opportunities that lie ahead for HIQA as our role continues to evolve.
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