Independent inspections to focus on patients' needs

ANALYSIS:FOR YEARS, the gaping flaws in our system of inspection for nursing homes has been plain to see. One arm of the Health Service Executive is inspecting nursing homes which another arm of the HSE funds, creating a major conflict of interest over whether to close sub-standard homes down

When homes failed so badly that authorities couldn't ignore then anymore, the HSE faced major legal difficulties in closing them down. Part of the problem was that regulations were so vague it was difficult to prove that a nursing home was in breach of its obligations. The situation has been arguably worse with public nursing homes, which have never been subject to any inspection.

It took a series of high-profile cases of abuse and mistreatment of nursing home residents, culminating in Leas Cross, before the political system was jolted into action.

Yesterday's publication of new standards, aimed at providing more robust protection of patients' rights, represents a significant improvement in the regulatory system. Under the new system, all nursing homes, both public and private, will be subject to independent inspections by teams attached to the Health Information Quality Authority. A set of minimum standards will apply to all residential settings that care for older people and for which registration is required.

But perhaps the biggest change will be the focus of inspections on individual patients rather than just ticking boxes. Instead of "one size fits all" staffing ratios, for example, the emphasis will be on evidence that patients are being looked after properly and that individual needs are being met.

Patients will also have to be consulted over their care, how their day is structured and will have written contracts setting out what services they are entitled to.

Meeting the new standards will be daunting for many nursing homes, particularly those in the private sector. As many as one-quarter of public nursing homes are more than 100 years old, meaning that significant structural works will be needed to bring care homes up to standard.

Another challenge will be changing the mindset of nursing home operators to include residents to a greater extent in the planning and delivery of services.

While the standards will help deliver better quality care, it would be naive to think they will rid the system of abuse. In the UK, where standards have been in place for several years, there are still cases of abuse.

A more robust system of inspection and regulation will, however, help to minimise this risk. It will make operators focused on making a quick buck think twice about entering the system and, ultimately, it may help restore some badly-needed public confidence in the sector.