The Regulation and Quality Improvement Authority (RQIA) is Northern Ireland's independent health and social care regulator. In its work RQIA encourages continuous improvement in the quality of health and social care services through a programme of inspections and reviews. Visit our about us section to find out more.
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Latest News (Updated 18 December 2014)
RQIA E-Zine Published (Updated December 2014)RQIA's latest E-Zine, Assurance Challenge Improvement, providing an update on the latest RQIA activities has now been published.
To access this E-Zine, click here.
Mental Health Part IV Medical Practitioners
RQIA is inviting applications for Medical Practitioners to undertake second opinions in accordance with Part IV of the Mental Health Northern Ireland Order 1986. For further information on how to make an application click on the document below:
RQIA publishes the findings of its Review of Implementation of GAIN Guidelines on Caring for People with a Learning Disability in General Hospital Settings (18 December 2014).
The Guideline on Caring for People with a Learning Disability in General Hospital Settings was published by GAIN in June 2010, detailing specific requirements for people with a learning disability who use general hospital settings. These include: communication; training for hospital staff; attendance at emergency care services; discharge planning; and support for carers.
“People with learning disabilities are very clear that healthcare staff should look at, and speak to them first, and focus on them, rather than directing attention to carers or parents. Service users who contributed to the review expressed their negative experiences of staff talking around the person with learning disabilities. Using terminology that does not devalue or stigmatise individuals is an important element in ensuring that people with learning disabilities feel included and valued when they are in receipt of services. During the review, this was raised frequently by service users and carers as a problem that immediately creates barriers to good therapeutic and respectful relationships. The only acceptable term is “person with a learning disability”.
The review team raised concerns around misunderstanding and poor practice in relation to consent, capacity assessment, best interest decisions and resuscitation orders. While the review team was satisfied that there is sufficient guidance, policy and professional codes to inform and guide clinical practice, on many occasions these were not followed. The review team found that linkages and liaison between general hospital services and learning disability services was variable and dependent on the insight of individual members of staff, rather than a structured and formalised process. RQIA recommends that each HSC trust should ensure that there are clear lines of communication and robust linkages between learning disability services and general hospitals.
While all health and social care trusts have processes in place to implement GAIN guidelines, RQIA considers that trusts need more robust procedures for monitoring progress, ensuring there are appropriate reporting mechanisms in place at director and trust board level.
RQIA makes 19 recommendations, which, if implemented we believe will improve the level of care experienced by people with a learning disability in general hospital settings.
You can read the full report here.
RQIA Calls For Improvements in Northern Ireland’s Stroke Services
RQIA has published the findings of its review of Stroke Services in Northern Ireland.
Since 2008, the Regional Stroke Strategy Implementation Group has taken forward the implementation of the Northern Ireland stroke strategy with the HSC trusts. While much progress has been achieved, further work is required in the implementation of a number of the strategy’s recommendations.
While most patients were admitted to stroke wards, some were initially transferred to other wards due to bed capacity pressures. In cases where stroke patients were placed in outlying wards, their level of stroke care and rehabilitation was not always as comprehensive as that received in a dedicated stroke unit.
The team found that communication with patients regarding their condition, treatment and support needs to be improved, an area that could also benefit from a regional approach. They also noted there was evidence of limited engagement and communication between secondary and primary care. For improved patient outcomes, this is an area that needs to be reviewed and developed.
Across Northern Ireland, stroke teams were found to be committed and enthusiastic, and they demonstrate a genuine sense of teamwork and willingness to provide high quality stroke care.
This review makes 22 recommendations to improve the quality of stroke services across Northern Ireland for all those requiring this care.
You can read the full report here.
RQIA Publishes Review of the Implementation of the Royal Dental Hospital Inquiry Action Plan
RQIA has published its Review of the Implementation of the Royal Dental Hospital Inquiry Action Plan. The review was commissioned by DHSSPS in November 2013 following the publication of the Dental Hospital Inquiry Action Plan (July 2013). RQIA examined the implementation of specific actions relating to the Belfast Trust and the Health and Social Care Board, and found that of these 22 actions, 15 were fully implemented, while seven required further work.
RQIA notes strengthened governance arrangements at the Royal Dental Hospital, and welcomes that staff are clearer in their roles and responsibilities in relation to patient safety. However, long-term staffing arrangements to ensure sustainability of oral medicine and other dental services should be reviewed, as should arrangements for succession planning at the hospital. The review team has recommended that the Belfast Trust focuses on completing the refurbishment of the Royal Dental Hospital; developing the patient and staff outcome measures; and the involvement of service users in planning, developing and monitoring the services at the Royal Dental Hospital.
RQIA will conduct a further assessment of progress against the action plan during 2015-16.
You can read the full report here.
RQIA Publishes Review of Discharge Arrangements
RQIA has just published the findings of its Review of Discharge Arrangements from Acute Hospitals.
The review team noted that, at present, elements of the patient journey leading to discharge are fragmented, and recommended that trusts resolve the obstacles hindering effective discharge planning. Delays ranged from two hours to several days. Health and social care trusts should provide a system that allows discharges to take effect across a seven day working week. They should plan for discharge from the point of admission and coordinate arrangements for the provision of medicines, discharge letters, and transport for patients who require help going home.
The review team also noted that some discharge summaries continue to be handwritten - in contravention of accepted guidance. The review team recommended that all trusts should fully implement electronic production and transmission of discharge summaries and ensure that no hand written summaries are produced. These should be sent directly to GPs, and not sent home with patients to pass on to their GP.
The review report makes 20 recommendations to improve discharge arrangements from hospitals across Northern Ireland.
RQIA Publishes Follow-up Inspection of Royal Victoria Hospital
In January 2014, following the declaration of a major incident at Royal Victoria Hospital, and whistleblowing concerns raised by medical staff, RQIA conducted a four-day inspection at the hospital. The published inspection report included a quality improvement plan, detailing how the Belfast Trust would address the recommendations.
During a follow-up inspection in May to assess progress against the 57 recommendations for improvement, RQIA noted that although progress had been made to address some recommendations, a concerted effort was required to ensure recommendations were actioned and implemented in full.
At the May follow-up inspection, 12 of the recommendations had been addressed; 12 addressed in principle; 29 were partially addressed; and four had not been addressed.
Improvements were noted in staffing levels in the Emergency Department and Acute Medical Unit, and hospital staff noted an improvement in the organisational culture, and stated that more support was available. They also commented that senior staff were more visible, supportive and engaged positively. However, they also indicated there were continued challenges in ensuring the smooth flow of patients across the hospital.
While the number of patients being cared for outside the areas designed to deliver their care and treatment had reduced, this issue continued to impact on the experience of some patients, and on patient safety. Maintaining the privacy and dignity of patients also remained an issue.
RQIA will conduct further inspection later this year to assess the Belfast Trust’s progress in achieving these recommendations. To view the follow-up inspection report, click here.
Child Sexual Exploitation Inquiry Report Published
Following its submission to the ministers for health, justice and education on 13 November 2014, the report of the Independent Inquiry into Child Sexual Exploitation in Northern Ireland is published today.
Kathleen Marshall, Inquiry lead said: “Child sexual exploitation is not new, but it has become a more significant threat to a greater number of children and young people with ready access to the internet. While it is difficult to assess the extent of child sexual exploitation, the indications are that it is widespread and growing. It is not restricted to children in care.”
Mrs Marshall: “At some levels, child sexual exploitation takes forms similar to those seen elsewhere, however, there are Northern Ireland-specific dimensions related, in particular, to the influence of powerful individuals in some communities.”
A key element of this inquiry was strong engagement with young people, parents, professional and community groups and a range of statutory and voluntary agencies across the health, social care, justice and education sectors.
The inquiry makes 17 key recommendations, and a further 60 supporting recommendations to the ministers for health, justice and education.
To view the full report as well as the executive summary and associated documents, click here.
World Quality Day 2014
Today (13 November 2014) marks Annual World Quality Day. The purpose of World Quality Day is to promote awareness of quality around the world and encourage development and prosperity. To read RQIA's 2013-14 Annual Quality Report, click here.
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