The Health Information and Quality Authority aims to applaud good practice and remedy bad, writes David Labanyi
A forensic assessment of standards in the health service will get under way early next year. The process will include visits to hospitals and nursing homes as well as interviews with staff.
Spearheading the move will be several hundred staff from the Health Information and Quality Authority (HIQA). Its formation was one of the key reform proposals in the National Health Strategy (2001) and legislation establishing it is due before the Dáil this term.
The HIQA will be separate from both the HSE and the Department of Health and its job will be to monitor the health services and identify good and bad practice. The audits are the first step.
According to its recently appointed chief executive, Dr Tracey Cooper, as the audit of health service standards commences, the HIQA will seek to "applaud good practice and remedy bad practice". The agency will have significant powers and while it will endeavour to work by consensus, it will have the authority to suspend or close a health service provider.
Cooper stresses that the new body will not become another quango of bureaucrats. It will be, she says, "an independent, objective, advocate of the citizen", concentrating on how a patient gets access to the care they need.
It is already functioning in an interim capacity pending the legislation and is engaged in a series of talks with stakeholders, including the Medical Council, patient groups and regulatory bodies, to agree how the audits can be achieved.
The agency has four key roles. "The first is to set standards; what is safe, what is responsive, not only across Ireland but internationally. We will be able to see that a service is within normal parameters and identify abnormalities, such as complications post-operation," says Cooper.
Its second function is to quality-assure these standards. "We will be doing reviews of hospitals and other service providers to ensure their ability to provide well-governed, safe services." These reviews will be published.
As part of the quality assurance, HIQA will track a patient's care across a range of service providers. "Take cancer services: we will look at primary care, community care, hospital care, to see how the different agencies interact, whether a patient has difficulties moving between service providers," she says.
The issue of where health services are located will not be directly addressed by the HIQA and will remain the job of the HSE. However, if dangerous practices are identified by the HIQA, it has the authority to recommend the closure of that service provider.
The third responsibility is inspecting social service providers and taking over the running of the national cancer registry and the health service accreditation board. Currently, social services for children are inspected but this will be expanded to include disability services and those for the elderly.
Services for the elderly and residential care, currently inspected by the social services inspectorate or by the HSE, will shortly become the HIQA's responsibility, with inspectorate staff joining HIQA.
This is the first stage of recruitment for the HIQA, which will have a final workforce of "several hundred". The size of HIQA's budget is being discussed with the Department of Health.
The final core element of HIQA will be assessing the efficacy and appropriateness of drugs and medical devices. "We will review current drugs and future drugs, current equipment and future equipment and devices.
"The research and evaluation process looks at a drug, and any similar drugs and then examines economic issues, the effectiveness of the treatment and then HIQA will provide advice," says Cooper. Not every drug or device will be reviewed, only those in priority areas or areas with high prescribing rates.
On foot of this research Cooper expects HIQA to have a key role in all significant future ICT and health information decisions.
An example of a project for assessment would be a project such as the PPARS system. According to Cooper, HIQA will advise whether a new product is "fit for purpose".
Prior to taking up her role, Cooper worked in surgery and A&E units in Britain. In 2001 she joined the clinical governance support team in the UK, and was appointed director of operations three years later.
According to Cooper, she has kept "a watching brief" on the reform process of the health service and says when she saw the role of HIQA chief executive advertised, she knew she wanted it.
She says the new agency will be "unique worldwide". All of its proposed functions are being used by international health services, but this will be the first time they have been brought together into one body.
"It all comes down to quality. As a member of the public, when I am accessing public services, if I contract breast cancer, I assume, and I have the right to assume, that every healthcare professional, every healthcare manager, every person who is an ambassador of the health services is properly trained and that the guidelines at work within the organisation are up to date."
Cooper admits not all of this will be achieved in five years - the duration of her contract. "For me to consider HIQA a success, in five years' time I have to be able to say the health services are better because and we can list the reasons."
She admits it will be a step-by-step process. "Firstly we have to examine the existing services, we can't improve unless we know where we are. That process is underway." HIQA has already commissioned a number of studies to assist with this assessment and will conduct further research once all its staff are in place.
The audits will identify good and bad practice among clinical teams, Cooper says. She also intends working with service providers to improve reporting on adverse incidents. She anticipates resistance from some sections of the medical profession. "There is a group of doctors who accepts the need for clinical governance.
"There is another group of doctors for whom the thought of scrutiny brings significant anxiety and that will manifest itself in resistance. This is not unique to Ireland, this happens worldwide when audit procedures are changed."
Since taking up her new job Cooper says she has identified a lack of clinical governance as the most significant weakness in the health services.
"I don't want HIQA to be a quango organisation that isn't able to add value to improve the services. I want to see improvements in the next five years and feel passionately around doing what's right for people."
