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.
To help improve the RQIA website for users, a number of cookies are in operation. To find out more click here.
Latest News (Updated 7 July 2016)
RQIA Publishes its Review of Governance Arrangements Relating to General Practitioner Services in Northern Ireland (July 2016)
As part of RQIA’s Three Year Review Programme 2015-18, RQIA has undertaken a review of governance arrangements and processes in place, to assure that services delivered by general practitioners (GPs) in Northern Ireland are safe, effective and compassionate. RQIA examined emerging issues in general practice that may impact on the safety and effectiveness of services, and sought the views and experiences of GPs to inform the review.
To support continued assurance in primary care medical services (general practitioners), the review team makes nine recommendations for improvement. These include: Arrangements to coordinate and take forward quality improvement in primary care; streamlining processes for serious adverse incidents(SAIs) involving primary care; and ensuring an appropriate delivery plan for Transforming Your Care’s shift of emphasis from secondary to primary care.
You can read this report here.
A summary leaflet is also available here.
Full Report of the Announced inspection of Maghaberry Prison, January 2016, Now Published
Today, Criminal Justice Inspection Northern Ireland (CJI) published the full report of the announced inspection of Maghaberry Prison carried out in January 2016 by CJI, RQIA, Her Majesty's Inspectorate of Prisons and the Education and Training Inspectorate. This reiterates the initial findings of the inspection team published in February, which assessed the nine recommendations made last year as partially achieved.
In response to a number of new concerns identified, inspectors recommend additional actions in relation to meeting the health care needs of prisoners. These are: ensure the closure of the inpatient unit is reviewed to meet the needs of the increasing number of prisoners with significant physical and mental health problems; and, ensure the increasing mental health needs of the population held are met.
You can read this report here.
RQIA Publishes First Unannounced Acute Hospital Inspection
Today, RQIA has published the findings of its first acute hospital inspection, which took place at Antrim Area Hospital in October 2015. This programme of unannounced inspections, commissioned by the Health Minister in 2014, aims to provide assurance to the public about the quality of hospital services, and to contribute to improvements in the delivery of care - through identifying what is working well and where further improvements are needed.
RQIA’s healthcare team conducted a three-day inspection at Antrim Area Hospital in late October 2015. The 20 member inspection team included lay assessors and medical, nursing, pharmacy and allied health professional peer reviewers. The inspection focused on three clinical areas, a medical ward, a surgical ward and the Emergency Department. In each area we assessed care in relation to safety, effectiveness, and whether it was being delivered compassionately. We also considered how it was being led and managed.
During the inspection, RQIA spoke to patients, relatives and staff; observed how care was being delivered; and examined care records.
At the end of the inspection visit, RQIA provided verbal feedback to the leaders in clinical areas and to senior management at the Northern Trust. Today, we have asked the trust - within four weeks of the publication of this report - to detail how it is addressing RQIA’s recommendations for each area inspected. You can read the full report here, You can read our press release here.
RQIA Publishes Overview of Quality Improvement Systems and Processes in Health and Social Care
Today, RQIA has published its overview of the current quality improvement systems and processes within health and social care organisations in Northern Ireland. These systems and processes often go unnoticed, but are the mechanisms behind improvements in safety, effectiveness and experience of care.
Within health and social care, work to improve the quality of services has been ongoing for many years. However, it is only in relatively recent years that organisations have adopted a systematic quality improvement approach. The publication of Quality 2020 by DHSSPS in 2011, to improve quality in health and social care in Northern Ireland has been a welcome step in bringing this forward.
RQIA found there is no integrated regional approach to quality improvement, with organisations taking different approaches, which has contributed to a perception that it is complex process. Despite this challenge, RQIA found much good quality improvement work being undertaken across all organisations.
In 2015, the then health minister announced the formation of an Improvement Institute, designed to drive forward innovation and quality improvement in health and social care services. In this report RQIA proposes 10 steps to further enhance quality improvement systems and processes, which may also help inform the development of the new Improvement Institute. You can read the report here.
Invitation to Apply for GAIN Funding 2017-18
RQIA’s Guidelines and Audit Implementation Network invites you to apply for funding for the development of regional health and social care guidelines or the undertaking of regional clinical audit. The closing dates for all applications is Friday 30 September 2016, and applications received after the closing date will not be accepted. We will inform all applicants of our decision by December 2016. To access application forms and further guidance, click here.
We Need Your Help: RQIA is Recruiting Lay Assessors
Are you interested in helping to improve the quality of health and social care in Northern Ireland? If so, RQIA is seeking to recruit a number of voluntary lay assessors.
Service users and members of the public bring their own experience, and can provide a fresh insight and a public focus to our work. This includes:
• inspections of care services, hospitals and mental health/learning disability services
• reviews of a range of health and social care services
Please note: At this time we will be accepting a maximum of 30 applications.
Review of HSC Trusts’ Readiness to Comply with Allied Health Professions Professional Assurance Framework
As part of its review programme, RQIA assessed the governance arrangements in HSC trusts in relation to allied health professions (AHPs), using the DHSSPS draft Professional Assurance Framework for AHPs.
This framework is designed to provide assurance that effective processes are in place within trusts, to develop, support and monitor AHP workforce compliance within agreed governance frameworks. RQIA’s review examined trusts’ readiness to comply with the draft AHP Framework, which supports their ability to fulfil their professional roles. The review also provided an opportunity for trusts to comment on the structure and content of the framework, prior to its publication.
As part of our review, we also assessed the arrangements in place in HSC trusts to ensure that AHPs meet the requirements to maintain their professional regulation.
RQIA’s review makes 16 recommendations for the Department of Health, HSC Board and HSC trusts, which aim to improve the professional assurance arrangements for AHPs in Northern Ireland. You can read the full report here, or alternatively, read our short summary leaflet here.
RQIA Appoints New Chief Executive
At RQIA’s Board meeting on 9 June, Chairman, Dr Alan Lennon, announced the appointment of Olive MacLeod as Chief Executive. Dr Lennon said: “I am delighted to welcome Olive MacLeod to RQIA, who will take up post on 1 July 2016. Olive brings a wealth of experience to RQIA, having worked in a wide range of health and social care organisations throughout her career, which, I believe, will further strengthen RQIA at this time. I congratulate Olive MacLeod on her appointment and wish her every success in this challenging role.”
To view the full press release, click here.
Upgrade of RQIA's Website
In order to improve the user experience, we are currently working to upgrade our website. Our new site will 'go live' in the next few weeks.In the meantime, there may be a certain amount of disruption to our current site, with certain documents and reports not available online. If you are unable to find what you're looking for, please email firstname.lastname@example.org. We apologise for inconvenience this may cause.
RQIA E-Zine Published (Updated April 2016)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.
Consultation on RQIA's Revised Inspection Policy for Regulated Services, March - April 2016
As part of RQIA's ongoing improvement activities, we have revised our inspection policy for regulated services, which we believe will have a positive impact on outcomes for service users. We sought your views on our proposed new assessment framework and report format. You can still view the consultation document, however the consultation has now closed. To view RQIA's press release on the consultation, click here.
Thank you to all those who provided feedback.
If you require further information, or have a query on this consultation, please email email@example.com.
RQIA Calls for New Strategy for Northern Ireland’s Ambulance Services
RQIA has published its review of the Northern Ireland Ambulance Service (NIAS), which follows up on RQIA’s recommendations from the previous review of NIAS in 2011, and from RQIA’s review of unscheduled care in 2014.
While RQIA noted that progress has been made in the development of a programme of clinical pathways and approaches to avoid the need for patients to be transported to hospital emergency departments, RQIA recommends that NIAS to work to progress those areas for improvement which remain outstanding.
The last strategic review of ambulance services in Northern Ireland was published in 2000. Since then there have been very significant changes in how ambulance services are delivered, with a growing recognition of its importance of its key role in underpinning the delivery of new models of patient care in Northern Ireland. A key recommendation is the call for the development of a new strategy for ambulance services, to define the roles of the service in emergency and unscheduled care, and as a key partner in the health and social care system in Northern Ireland.
RQIA welcomes the ambulance service’s plans for a clinical support desk to support new models of care that would allow staff to ‘treat and leave’ or treat and refer’ patients who may not require to be brought to hospital emergency departments, and recommends that this is progressed.”
This review makes a total of nine recommendations in relation to issues including service improvement, staff training, ICT and communication. The review team also recommends the development of a new performance framework, prioritising clinical outcomes, and ensuring that time-based outcomes relate only to time-critical calls.
RQIA believes that by addressing the recommendations in this review, NIAS can improve further the service it provides for all patients.
Initial findings of Announced Follow-up Inspection of Maghaberry Prison Published
RQIA, Criminal Justice Inspection, Her Majesty's Inspectorate of Prisons and the Education and Training Inspectorate have published the initial findings of an inspection of Maghaberry Prison in January 2016. This followed up on serious concerns identified in the previous inspection conducted in May 2015. While inspectors found that the prison has stabilised this was progress was considered fragile.
In relation to health care, while some aspects of primary health care had improved since May 2015, it was very worrying that mental health provision had deteriorated as a result of staff shortages and now needed urgent attention. Given the vulnerability of many of the men in Maghaberry Prison and the prevalence of such health problems, this was a significant additional area of concern. These concerns have been brought to the attention of the South Eastern Health and Social Care Trust which has advised that it is prioritising this issue.
As an indication of the commitment of each inspection body to ensuring inspection recommendations are addressed, a series of announced, low-impact visits to the prison will be conducted over the next 18 month.
RQIA Publishes Review of Community Respiratory Services in Northern Ireland
Death rates from respiratory disease in the UK and Ireland rank among the worst in Europe. Each year in Northern Ireland, there are over 10,000 admissions to hospital for respiratory problems, including chronic obstructive pulmonary disease (COPD). Some 2,000 people will die from a respiratory condition, accounting for around one in seven of all deaths.
In its review of Northern Ireland’s Community Respiratory Services, RQIA’s review team found that improvements are needed to community respiratory services to avoid unnecessary admission to hospital, and to extend availability into the evening and weekends.
The review team highlighted the need for equal access to services across Northern Ireland for every patient, and for stronger integration across primary, community and acute services - from prevention to palliative and end of life care. Patients also called for better information on the services available.
RQIA’s review team found a committed community respiratory services workforce, providing a patient-centred service for those with long-term respiratory conditions across Northern Ireland. This view was also endorsed by those using the services.
RQIA’s review makes 13 key recommendations for the HSC Board and all trusts, with 17 supporting recommendations for the HSC Board and individual trusts, which aim to improve the quality of community respiratory services for patients across Northern Ireland.
RQIA Publishes Independent Review of Implementation of Palliative and End of Life Care Strategy
RQIA has just published the findings of its review of the implementation of Living Matters Dying Matters. (DHSSPS, 2010), Northern Ireland’s Palliative and End of Life Care Strategy.
RQIA’s review team found progress in taking the strategy forward, facilitated by strongly committed leaders from statutory and voluntary sector organisations. Although many initiatives have been developed to raise awareness of palliative and end of life care, there remains a significant lack of understanding about these services amongst the public. RQIA also noted a lack of clarity on how the range of regional structures fitted together.
A key principle within the strategy is that each person should have a key worker to coordinate the delivery of their palliative and end of life care needs. While this is being actively taken forward in community settings, it is less clear how it operates in hospitals. The team also noted that there was no consistent approach across Northern Ireland, and recommends that regional coordination arrangements should be strengthened, to ensure better outcomes.
This review makes a total of eight recommendations for improvement, including the need for a new action plan for the next three-years (2016-19), building on what has already been achieved. Click here to read the full review report. You can also read a summary leaflet here.
RQIA Publishes its Review of Advocacy Services for Children and Adults in Northern Ireland
As part of RQIA’s Three Year Review Programme, 2015-18, DHSSPS commissioned RQIA to conduct a review of the commissioning arrangements for the provision of Advocacy Services for Children and Adults in Northern Ireland. RQIA’s review team considered these in the context of the principles and standards set out in Developing Advocacy Services, DHSSPS, 2012.
While RQIA was provided with examples demonstrating recognition by HSC organisations of the importance of independent advocacy services, the review team identified a number of constraints that impact on their delivery. These included: no clear statutory duty or strategic framework to provide independent advocacy services in Northern Ireland; resource issues; and an absence of regulation of advocacy providers.
RQIA found that the provision of advocacy services varies across geographical areas and HSC trust programmes of care. Most advocacy services are provided for mental health, learning disability, and family and children’s services. In most HSC trusts, there is limited investment in advocacy for individuals in other programmes of care. RQIA’s review team also noted that the future direction of advocacy services will be impacted by forthcoming mental capacity legislation.
RQIA makes eight recommendations for improvements in the commissioning and quality of advocacy services for children and adults in Northern Ireland.
You can access the full report here.
RQIA E-Zine Published (Updated December 2015)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.
RQIA Publishes its Review of Eating Disorder Services in Northern Ireland (18 December 2015)
RQIA has now published the findings of its Review of Eating Disorder Services in Northern Ireland.
During the review, RQIA held a series of focus groups with adults and young people with an eating disorder and with their families. The review team also met with health and social care staff responsible for commissioning and providing services, and with representatives from voluntary organisations.
While anyone can develop an eating disorder, regardless of age or gender, the most commonly affected group are young women between the ages of 15 and 25. It can be difficult to identify the early stages of an eating disorder, and these disorders are often associated with psychiatric and physical complications.
Early intervention and the development of clear treatment pathways is crucial for anyone with an eating disorder. The experiences of service users’ initial contact with GPs, and their subsequent referral into other essential services were mixed. Parents and carers told us that advice was not consistently available to help them cope with living with someone with an eating disorder.
In recent years there has been an increase in the numbers of patients referred to hospitals to Great Britain and the Republic of Ireland. RQIA recommends that there should be a feasibility study to determine if a specialist eating disorder unit should be developed in Northern Ireland, and welcomes the Health Minister’s statement in October 2015 on this matter. Engagement with patients who have been subject to these referrals is also critical in the future development of eating disorder services.
This review makes 11 key recommendations and 15 supporting recommendations, which, if implemented, would improve services for all those in Northern Ireland with an eating disorder.
The Health Minister has welcomed the publication of RQIA's report and you can access his statement here.
Review of HSC Trusts’ Arrangements for the Registration and Inspection of Early Years Services (01 December 2015)
RQIA’s review team found that all trusts have arrangements for their registration and inspection and maintain up-to-date registers of providers. However, areas for improvement to the inspection processes were identified by RQIA. These included: the development of more robust arrangements for appeals and enforcement; more person centred inspections; and ensuring inspection reports are shared with providers.
RQIA’s review team also recommended improvements in training for early years teams, in areas such as child protection, safeguarding and child development. RQIA also noted that issues in relation to consistency in HSC trusts’ interpretation of the Minimum Standards for Childminding and Day Care of Children Aged under 12 (2012) needed to be resolved.
The report makes 17 recommendations for improvement to the arrangements for registration and inspection of early years services.
RQIA E-Zine Published (November 2015)
Welcome to the ninth edition of Assurance, Challenge and Improvement, RQIA’s latest electronic newsletter (e-zine). In this issue find out more about our programme of unannounced of acute hospital inspections, which started last month with a three-day inspection of Antrim Area Hospital.
You can read about RQIA’s latest publications, including our Annual Report, review of brain injury services and our joint inspection of Maghaberry Prison. In November, we hosted a world leading expert on children’s homes who led a symposium on residential child care. You can also read more about our reviews activities and key developments in regulation, review and mental health and learning disability in recent months.
You can access further information by clicking on the blue hyperlinks throughout this newsletter/e-zine. Click to access details about RQIA’s key functions. And, don’t forget, please complete our short survey!
Symposium on Residential Child Care
In November, forty delegates attended RQIA’s symposium on residential child care. The keynote speaker was Professor Jim Anglin, School of Child and Youth Care at University of Victoria, British Columbia, Canada, who provided a presentation on best practice in this area. You can read Professor Anglin’s presentation here.
RQIA Annual Quality Report 2014-15
Today (12 November 2015) marks Annual World Quality Day, which promotes awareness of quality around the world and encourages development and prosperity. To read RQIA's 2014-15 Annual Quality Report, click here.
Unannounced Inspection of Maghaberry Prison Published
RQIA, in partnership with Criminal Justice Inspection, Her Majesty's Inspectorate of Prisons and the Education and Training Inspectorate (ETI) conducted an unannounced inspection of Maghaberry Prison in May 2015.During the inspection, RQIA identified serious concerns about aspects of health care provision for prisoners at Maghaberry. Of particular concern were difficulties in the recruitment and retention of staff, which affected key aspects of health care delivery at the prison. This included the management of the care of prisoners with chronic diseases such as asthma and diabetes. Prisoners reported unacceptably long waits to see a GP, nurse or dentist. Our inspectors found delays and serious problems in the administration of medication. The practice of prisoners holding their own prescribed drugs created a risk of medicines being diverted, and vulnerable prisoners bullied. RQIA provided feedback on our concerns to the South Eastern Health and Social Care Trust, both during and following the inspection, to ensure immediate action. Today’s joint report recommends that the South Eastern Trust provides a formal action plan to RQIA within one month to address the serious concerns identified and to ensure patient safety. While actions already taken by the trust since this inspection are welcomed, a further inspection will take place in January 2016 to assess progress in addressing the concerns identified in this report. You can read the full report here.
RQIA To Commence Unannounced Acute Hospital Inspection Programme
RQIA is launching a significant addition to our work through a new programme of unannounced inspections at every acute hospital in Northern Ireland, which will begin this month (October 2015).To provide assurance to the public, this month we will begin our new programme of unannounced inspections at acute hospitals across Northern Ireland. Our inspections will identify and report on what is working well, and where improvements are needed, with a focus on increasing the quality of care and reducing harm to patients. Our inspectors will assess: Is care safe? Is care effective? Is care compassionate? We will also examine the quality of leadership and management at each area inspected. During each unannounced inspection our team will visit a number of specific clinical areas within the hospital. To help provide a clear view of the overall performance of each area inspected, we will: inspect the hospital environment; observe practice; speak to patients, families and staff; and examine evidence including: patient records, policies and other relevant documentation. At each hospital, RQIA will lead inspection teams which will include doctors, nurses, pharmacists, ambulance staff and allied health professionals - who are engaged in the daily delivery of health and social care elsewhere in Northern Ireland - as peer reviewers. Equally important is the involvement of lay assessors - service users and members of the public, who bring their own experience, fresh insight and a public focus to these inspections. Read our press release here. Find out more about how we will conduct our new acute hospital inspections here.
RQIA Publishes Review of Services for People with an Acquired Brain Injury (Updated 23 September 2015)
RQIA has published the report of its independent Review of Brain Injury Services in Northern Ireland.
Each year, in Northern Ireland over 2,000 people sustain a brain injury, while many more live with the long-term effects.
The review team, which included experts in the field from across the UK, assessed acquired brain injury services against brain injury service standards and quality indicators.
To achieve best outcomes for people with a brain injury, collaborative working arrangements are required to drive service improvement and to share innovation. The review team calls for a strategic direction for brain injury services to facilitate better coordination of services across the five health and social care trusts.
While information on both adult and children’s services was available, the review team recommends that trusts should involve service users, their families and carers in reviewing how and when this information is provided.
This review makes 23 recommendations to support improvements in the provision of brain injury services, the recommendations to improve patient care require particular consideration by the DHSSPS, HSC Board and trusts.
You can read this review report here.
Public Health Agency Offering Free Training for Nursing and Residential Care Homes on Nutritional Guidelines and Menu Checklist
From September 2015 until January 2016, the Public Health Agency is offering free training at venues across Northern Ireland for nursing and residential care homes on Nutritional Guidelines and Menu Checklist. For further details of dates and venues 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 here.
RQIA E-Zine Published (August 2015)
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.
RQIA Review of Medicines Optimisation in Primary Care (Updated 29 July 2015)
RQIA has published the report of its Review of Medicines Optimisation in Primary Care. Northern Ireland has an ageing population, which is likely to increase the number of people with multiple medical conditions, leading to greater use of complicated medicines regimens. RQIA assessed present medicines optimisation processes in Northern Ireland, aligned to DHSSPS’s Medicines Optimisation Quality Framework for Northern Ireland, and this report makes 16 recommendations to improve medicines optimisation processes in primary care.
You can read this review report here.
Animated Summary of RQIA's Independent Inquiry into Child Sexual Exploitation (CSE) in Northern Ireland (Updated 16 June 2015)
In November 2014 the findings of the Independent Inquiry into Child Sexual Exploitation in Northern Ireland were published. During the inquiry, it was agreed that a child/young person friendly summary would be produced. Include Youth brought together a group of young people who have made a short animation on the inquiry’s key messages and contact details for
help and support
on CSE. Watch the animation here:
to find Inspection reports. Enforcement Activity
to access details of enforcement. Register of services
to view our register. Feedback and complaints
for guidance. Whistleblowing
for guidance on whistleblowing. Freedom of Information (FOI)
for information on FOI.