Second Opinion: Hiqa’s job is not just a ‘paper exercise’ and should be taken seriously

Working for the Health Information and Quality Authority (Hiqa) can’t be easy. The organisation is in the news nearly every day and publishes several reports a week, almost all of them with some negative findings.

There seems to be no end to poor professional practice. Nurses are particularly incensed by recent reports. At the INMO conference in May, they demanded an independent review to establish whether Hiqa “has actually improved the quality and standard of care for patients in Ireland”. A member of the INMO’s executive council described Hiqa’s standards as “paper exercises in rubbish”.

Four months ago, in an address to the National Disability Summit, Phelim Quinn, the chief executive of the authority, said, “It is disturbing and chilling to have to say that the sorts of issues we have seen in recent weeks and months resonate with care practices and culture that were thought to have been confined to the past.” He described what Hiqa’s inspectors have seen as indicative of cultures so ingrained that health professionals seem “unable to distinguish between what is an acceptable and unacceptable standard of care”.

Hiqa has the statutory role to set and monitor compliance with standards for the quality and safety of health and social services in Ireland provided or funded by the HSE. Exceptions are mental health services, which are regulated by the Mental Health Commission, and private healthcare providers.

Far from being “paper exercises” in rubbish, the national standards were approved by the Minister for Health in May 2012 and, in accordance with the Health Act 2007, the authority monitors compliance with them. Health professionals are obliged to take them seriously.

Standards

There are 45 standards altogether, divided into eight key themes including person-centred care, better health and wellbeing, and leadership, governance and management.

The standards mean service users are, or ought to be, treated with kindness and respect, and experience the best achievable outcomes. Management must use resources wisely and be accountable to stakeholders. Information – such as patients’ notes – must be accurate, reliable, legible and complete. These standards ensure that citizens get, or ought to get, safe, high-quality services.

Hiqa is also responsible for driving quality, safety, and accountability in residential services for children, older people, people with disabilities and children in foster care.

Wasteful medical practices happen because of defensive medicine, patient pressures and conflicts of interest. The UK’s National Institute for Health and Care Excellence (NICE) has identified more than 800 useless clinical procedures. Hiqa has a similar role and carries out Health Technology Assessments (HTAs), which set thresholds for surgical procedures. Unless service users reach these thresholds they should not be referred for treatment.

The HTA for haemorrhoids notes that, in the absence of symptoms suspicious for malignancy, patients can be managed in primary care by measures such as increasing dietary fibre.

A HTA on hernias found that men with asymptomatic hernias may be managed by a “watch and wait” policy. Patients with a body mass index (BMI) greater than 40 should be referred to a weight-reduction programme before having hip-replacement surgery.

HTAs are designed to save millions of euro by ensuring that only service users who will benefit from surgical procedures receive them.

Recommendations

A new analysis of seven major Hiqa reports with 232 recommendations between them found that the same recommendations are made over and over again.

Linking Learning to National Standards: How recommendations from previous Hiqa

investigations, statutory inquiry and review reports (2009-2015) relate to specific National Standards for Safer Better Healthcare

shows that recommendations are linked to three main themes: leadership, governance and management; effective care and support; and the health workforce.

Recommendations about effective corporate and clinical governance were made 62 times in the seven reports. The analysis concludes that “it is important for each service provider to look at the national standard associated with the recommendation to ensure their service meets the demand”.

Hiqa is doing a great job on behalf of citizens and is committed to taking an increased rights-based focus in its inspection programmes. In future, inspectors will not only check compliance with standards, but will point out when services appear to be breaching the rights of service users through negative cultures. Amen to that.

However, unless HSE employees and other service providers take the standards seriously and implement report recommendations, nothing will change. Powerful health unions must not get away with treating Hiqa’s work as “paper exercises in rubbish”. Surely professionals and Hiqa are, or ought to be, on the same side.

drjackyjones@gmail.com

Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Health Ireland Council.