I want to thank you all for your attendance here this evening to mark 10 years of HIQA’s existence and its contribution to Ireland’s health and social care system. I specifically want to acknowledge the contributions made already this evening by Dr Raphael Bengoa, Tony O’Brien and Jim Breslin. I believe their contributions should be a starting point for conversations on how each of us with a stake in making services safer and better can build further collaborations whilst acknowledging our respective roles and accountabilities.
In marking such a milestone, it would be easy for us in HIQA to fall into the trap of looking back and patting ourselves on the back for the great job we believe we have done in making services in Ireland safer, and the experience of those using services better.
But we know that we are on a journey and we are travelling that journey with many, if not all of you here tonight.
When HIQA was set up 10 years ago, there was a focus on the concept of independence – I think it’s understandable that HIQA’s independence was thought to be one of the key factors that would ensure public confidence and trust in what we set out to achieve.
Independence is still relevant. That has been evident from the positive public response to our past and ongoing assessments of health and social care services, sometimes in the aftermath of significant service failure. Independence is also vital in developing standards, guidelines and health technology assessments free from political interference. It is why it remains one of our key corporate objectives, and it is why we believe that we need to continue to preciously guard the principle of independence outlined in the Government’s original vision for HIQA.
In HIQA, we are constantly assessing what else needs to be done—how else can we, working with others, forge a better way forward for Ireland’s health and social care services? For this reason, when developing our corporate plan in 2016, we also set out with the specific objective to build and maintain key strategic and operational relationships with those that share our vision of safer, better services and, more importantly, those who still need to be convinced.
This month we see one of the most significant products of that process of relationship building—the commencement of the first ever National Patient Experience Survey in Ireland. This survey will provide us with access to up to 30,000 people who have spent 24 hours or more within our publicly-provided and funded hospitals. Whilst the product of the survey will undoubtedly offer us valuable information with a view to improving services, producing national and local policy and developing monitoring programmes, it has been the collaborative journey that we have shared that has been the most valuable outcome in the exercise.
When looking at the concept of integrated health, as referred to by Dr Bengoa this evening, I noted a recent article by Nick Goodwin in the International Journal of Integrated Care that clearly sets patient experience at the centre of successful integrated care programmes.
Goodwin notes that, at times, decision makers find it difficult to understand the financial value of measuring people’s care experiences in order to inform and promote more effective care-design processes. One of the reasons to collaborate on this and future patient experience surveys is to ensure that narrative of person-centred care is not drowned out by economic concerns.
Measuring people’s experience is important not only in guiding service improvement but also because people’s experiences of care have been shown to be linked to improved clinical outcomes and reduced costs. For example, a systematic review of 55 studies in primary care centres and hospitals found consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of diseases, settings, outcome measures and study designs. In theory, measuring care experiences should encourage better decision-making and lead to more effective service delivery.
The patient experience survey not only raises the possibility of further surveys, but also of future positive collaboration on other initiatives without threatening or damaging the integrity of HIQA’s role as the people’s independent health and social care watchdog.
In recent months, we were asked to provide evidence to the Oireachtas Committee on the Future of Healthcare. In our presentation, we were keen to reflect HIQA’s 10-year-experience of developing standards, providing technical advice and assessing the quality and safety of services. In line with our findings in several statutory investigations and reviews and in the regulation of residential services for older people and people with a disability, issues relating to accountability for the quality and safety of services have become a recurring theme.
As a regulator, HIQA believes that arrangements for the corporate, clinical and social governance of services are vital to provide assurance on compliance with regulations and standards. As such, we believe that those investing in or procuring services on behalf of the State should be anxious to ensure that what they are purchasing is safe, effective, of good quality and demonstrates value for money. In our evidence, we asked the committee consider the introduction of a commissioning model as part of any future structural reform. We believe that this model needs to apply to services at both the individual and national level.
I appreciate that the recent experience of commissioning in neighbouring jurisdictions has been dominated by issues of cost containment and a race to procure services at the cheapest rate. Therefore, it has the potential to make politicians anxious about the introduction of a similar model here. However, I believe that Ireland needs to develop its own evidence-based model of commissioning with a clear focus on quality, safety and compliance with human rights, while seeking to achieve value for money. A relationship can be developed between HIQA as the standards setter, technical advisor and regulator, and any future commissioning body. It is my view that such a collaboration has the potential to develop an Irish vision for the commissioning of health and social care services in a way that is right for our citizens and for our system.
It is worthy to note that HIQA and the HSE are exploring a small number of pilot initiatives in health and social care for 2018. This should enable both organisations to safely explore how information can be exchanged to:
- meet assessed need
- promote health and wellbeing
- support equitable and timely access to quality, safe services
- foster a culture that is honest, compassionate, transparent and accountable
- support the management of resources in a way that delivers best health outcomes, improves people’s experience of using the service and delivers values for money.
Over the last 10 years, HIQA has developed significant competence in evidence-based advice and standards development as well as working to improve the way in which we develop and leverage the vast amount of information that exists on the health and social care system.
HIQA has been engaged in the formal regulation of services to vulnerable people since 2009, commencing with residential services to older people and, more recently, in residential care for people with a disability. We believe that the introduction of regulation in these services was an acknowledgement on behalf of Government of the necessity to take steps to protect our vulnerable citizens.
However, we believe that gaps still remain in the regulation of health and social care services. A recent Red C Poll commissioned by HIQA shows that there is widespread misunderstanding of which areas of health and social care are currently independently regulated and monitored. Given the results, there may be some surprise among the public to discover that there is currently no independent regulation of private hospitals or homecare services. Indeed, as the poll shows, when people are informed that these services are not independently regulated, there is widespread support for it to be introduced.
In HIQA we are also concerned about the current and emerging models of regulation that continue to based on institutions and the services that are provided within them. In line with the concept of integrated health, we need to commence a conversation on regulatory reform based on systems and not on organisations or institutions. We need to ensure that regulatory reform is closely aligned to healthcare systems reform—regulation needs to remain relevant.
For example, a designated centre is defined as an institution where residential services are provided. Yet even now we have become increasingly aware of several different models of residential and non-residential care for older persons and people with disabilities; some of which do not sit within the current definition of a designated centre. This rigid adherence to the institutional model presents challenges in terms of ensuring that dependent and vulnerable individuals are protected.
Given the current appetite for reform in health and social care, HIQA believes that now is an opportune moment to reflect on how these services might be regulated. As such, HIQA initiated a series of conversations with stakeholders in Ireland and researched international models of regulation. We have now submitted the results of this work to the Minister for Health and the relevant Ministers of State. We presented proposals on how regulation of social care services may evolve into the future to afford maximum protections for those in receipt of services.
We urge the accelerated development of a licensing programme for healthcare services as was first suggested by the Commission for Patient Safety in 2008. We remain committed to working with our colleagues in the Department of Health to ensure the development of a model of regulation that is fit for purpose in the emerging context of Ireland’s healthcare services, both public and private.
We acknowledge that the Government has demonstrated a commitment to the promotion of the rights of vulnerable and disempowered individuals in the passing of the Assisted Decision-Making (Capacity) Act in 2015 and in the progress of the Disability (Miscellaneous Provisions) Bill through the Oireachtas. These pieces of legislation are aimed at ratifying the UN Convention on the Rights of People with Disabilities and dealing with issues surrounding the deprivation of liberty. In fact, HIQA has been assisting with the development of new codes of practice under the capacity legislation. However, we continue to be concerned at the lack of legislation that identifies the State’s responsibility to protect adults who may be vulnerable or subject to abuse or exploitation.
We are proud to be part of another major collaborative, the National Safeguarding Committee, and remain committed to promoting the development of safeguarding legislation as well as raising the public’s consciousness of the potential for abuse of people who may be vulnerable.
As you are aware, we are responsible for the regulation of children’s services. We welcome recent developments to ensure that the formal regulation of children’s residential services provided by the public, private and voluntary sectors will now be subject to registration and inspection. We would urge further regulatory reform in other services, particularly foster care services, where specific vulnerabilities have been identified.
When I took up the position of CEO of HIQA in 2014, I did so in the context of the solid foundations laid by my predecessors Tracey Cooper and Jane Grimson. They had built a strong, independent and recognisable brand in which the Irish public had confidence and trust. I believe the need for that strong, independent brand remains, but the context in which we operate requires us to recognise the fact that HIQA cannot build safer, better services by itself.
I have cited a range of initiatives and approaches that I believe would go some way to strengthening Ireland’s health and social care system. These initiatives will require political will and the collaboration of all stakeholders to ensure that we have a health service that is high quality and safe; a heath service that we can be proud of.
There’s a lot still to be done!
Go raibh maith agat