Hiqa’s powers of enforcement are ‘blunt instrument’, Oireachtas committee told

The Health Information and Quality Authority’s (Hiqa) powers of enforcement in regulating the nursing home sector are a blunt instrument, its chief executive has accepted.

Hiqa chief executive Phelim Quinn told the Oireachtas joint committee on health on Tuesday that it believed the provision of health and social services should be subject to a regulatory framework "which is fit for purpose, adaptable to changing needs and preferences, and responsive to risk and concerns for people's welfare".

Answering questions from David Cullinane of Sinn Féin, Mr Quinn said Hiqa at this stage did not have powers to initiate an investigation into individual complaints of abuse or neglect in private nursing homes.

He said adult safeguarding teams nor social workers did not have such powers either.

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Department of Health assistant secretary Kathleen MacLellan said it was a priority for it to examine how such complaints could be investigated and engagement was under way with Hiqa on this issue.

Mr Cullinane asked Mr Quinn whether Hiqa, as the regulator for the nursing home sector, had on a number of occasions since 2013 and up to 2020 highlighted, identified and sought a strengthening of regulations and powers including in the area of adult safeguarding and that “this had simply not happened”.

Mr Quinn said that was correct but there was a very good constructive engagement going on at present.

Mr Cullinane asked Mr Quinn whether Hiqa considered its powers of enforcement at present to be “a blunt instrument”.

Mr Quinn replied : “Yes, I suppose , in a very short answer.”

Mr Quinn said Hiqa had determined over the last 12 years that its powers of enforcement in the main related to the imposition of conditions on the registration of registered providers and up to cancellation of registration. He said part of the enforcement armoury included prosecution but prosecution would always be used as a last resort.

Mr Quinn said as part of proposals on regulatory reform Hiqa had sought an amendment to enforcement powers to introduce some form of graduated approach to improvement. He said this would allow Hiqa to serve a non-compliant provider with an improvement notice.

Ms MacLellan told the committee that a longer-term review of the regulation of nursing homes would commence next year.

She said in the meantime interim enhancements to the current regulatory framework for nursing homes this year had been approved by the Minister for Health Stephen Donnelly.

“Detailed work is advancing on legislative proposals, which subject to Government approval, will aim to enhance the enforcement and oversight powers of the chief inspector, including through additional enforcement tools such as compliance notices; obligations for all nursing homes to report key operational data to Hiqa and make it available to the public; exploration of measures to enhance transparency and increased legal underpinning of infection prevention and control obligations, along with other improvements. “

Ms MacLellan also said the Government would shortly be asked to approve the principle of moving to introduce a licensing framework for professional home support providers, underpinned by legislation, in line with a commitment in the the Programme for Government.

Mr Quinn said the Covid-19 pandemic had not in itself signalled the need for regulatory reform but “ rather it has shone a spotlight on an issue that was already in need of urgent consideration”.

“As a consequence of our experience as a regulator in the sector, Hiqa has submitted its views to Government on how regulations and enforcement in the interim of wider regulatory reform could be enhanced with a view to strengthening key areas related to the pandemic; for example, infection control, staffing, governance and clinical oversight.”