Unlike in the area of residential social care services, HIQA does not have the power to regulate acute general hospital services and has no enforcement powers. The powers within the Health Act 2007 enable HIQA to monitor public acute hospitals against nationally mandated standards. We publicly report our findings from these monitoring programmes in the interest of sharing learning and encouraging improvement. However, we do not have the power to enforce recommendations from this work.
In addition, the Health Act 2007 also gives us the power to conduct statutory investigations. We can investigate under Section 9 of the Health Act at the behest of the Minister or the Board of HIQA. However, as with our monitoring function, HIQA has no power and therefore no role in monitoring or ensuring that those recommendations are implemented.
The limitation in HIQA’s powers is clearly illustrated through HIQA’s assessment of acute hospital service through statutory investigations and monitoring exercises. In recent years, HIQA has made assessments of the quality and safety of a number of emergency department services including Tallaght, Limerick and Portlaoise. In all instances, HIQA clearly outlined through its findings and recommendations what measures were required to improve services. These findings and recommendations had implications for services locally and nationally. The responsibility for compliance with standards and the implementation of recommendations rests solely with the provider of services and where appropriately those charged with making policy.
The Health Information and Patient Safety Bill 2016 when passed by the Oireachtas and implemented will allow HIQA to extend our monitoring role into private healthcare but only within our current powers.
HIQA broadly welcomes the concept of licensing and welcomes the Health Information and Patient Safety Bill 2016, which is a broad piece of legislation that sets out a legislative framework for the better governance of health information and the mandatory reporting of patient safety incidents.
Based on our research on healthcare regulation internationally and our experience of regulating services provided and funded by the HSE, HIQA strongly supports the proposal to introduce a system of regulation to the private health sector.
However, it should be noted that the regulatory system in Ireland varies significantly to those in place in other countries as regards regulatory reach, monitoring and enforcement. The current programme, as funded by the Department of Health, merely allows for targeted monitoring in high-risk areas.
To date our programmes have focused on inspecting against standards in publicly funded acute hospitals, by monitoring key areas of patient safety and risk, including in the areas of medication safety, antibiotic resistance, infection prevention, and nutrition and hydration care in hospitals.
We have also conducted a review of pre-hospital emergency care services, including ambulances. While the Health Information and Patient Safety Bill 2016 potentially provides for greater oversight of private sector compliance with nationally-mandated standards, it is important to realise the limitations to HIQA’s legal powers.
The proposed Bill does not confer HIQA with the same powers of registration, inspection and enforcement that we have in the social care sector, such as in nursing homes and disability centres. HIQA can only work within the confines of its defined legal remit.
It is for this reason that we have worked with the Department of Health over many years to progress the Patient Safety Licensing Bill, which provides for the introduction of a more formal programme of regulation to private sector services.
The extension of HIQA’s remit in several areas, and amendments to the way we work under the Health Act 2007 will have considerable resource implications and HIQA will be required to take on a number of additional staff with specialist expertise.
Much preparatory work is required in advance of the commencement of the new functions and as such sufficient staff must also be in place at least six months prior to the commencement of any relevant legislation.