Health and Personal Social Services (Quality, Improvement and Regulation) Bill: Second Stage

– in the Northern Ireland Assembly at 11:15 am on 1 October 2002.

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Photo of Bairbre de Brún Bairbre de Brún Sinn Féin 11:15, 1 October 2002

Molaim go dtugtar a Dhara Céim don Bhille Sláinte, Seirbhísí Sóisialta agus Pearsanta (Cáilíocht, Feabhsúchán agus Rialachán).

Sa chaibidil ‘Ag Obair d’fhonn Pobal Níos Sláintiúla’ ina chéad Chlár Rialtais, thug an Coiste Feidhmiúcháin gealltanas creat a fheidhmiú le cáilíocht na seirbhísí a sholáthraíonn na seirbhísí sláinte, pearsanta agus sóisialta a ardú. Mar chéad chéim leis an ghealltanas seo a chomhlíonadh, chuir mé mo chuid moltaí, dar teideal ‘An Cleachtas is Fearr — An Cúram is Fearr’, faoi chomhairliúchán poiblí in Aibreán 2001. Léirigh na freagraí ar na moltaí seo go raibh tacaíocht leathan ann d’fheidhmiú na socruithe nua le taca a chur faoi cháilíocht na seirbhísí sláinte, pearsanta agus sóisialta agus le feabhas a chur ar rialú na seirbhísí agus leis an rialú sin a leathnú.

Foilsíodh torthaí an chomhairliúcháin ar 11 Meitheamh 2002. Ar an dáta céanna, d’fhógair mé mo chinntí ar phríomhghnéithe an chreata nua a leagadh amach le cáilíocht na seirbhísí cúraim agus sláinte a sholáthraítear anseo a chur chun cinn. Go bunúsach, is féidir príomhghnéithe an chreata a achoimriú mar seo leanas: córas le caighdeáin agus treoirlínte nua a fhorbairt nó na cinn atá ann cheana féin a chur i bhfeidhm; rialú na seirbhísí a leathnú le réimse i bhfad níos leithne seirbhísí a chlúdú; caighdeáin íosta cúraim a fhorbairt do sheirbhísí rialaithe; dualgas reachtúil cáilíochta a chur ar na seirbhísí sláinte, pearsanta agus sóisialta; córas rialachais ar chúram sóisialta cliniciúil a thabhairt isteach; comhlacht singil rialaithe agus cigireachta neamhspleách — údarás feabhsúcháin agus rialaithe na seirbhísí sláinte agus sóisialta — a bhunú ag a mbeidh an dá ról de sheirbhísí a rialú agus cigireacht a dhéanamh ar rialachas sna seirbhísí sláinte, pearsanta agus sóisialta; creataí forbartha seirbhíse cosúil le creataí na seirbhíse náisiúnta i Sasana, in Albain agus sa Bhreatain Bheag a fhorbairt nó a oiriúnú lena n-úsáid anseo; agus creat bainistíochta ar fheidhmíocht a fhorbairt.

I beg to move

That the Second Stage of the Health and Personal Social Services (Quality, Improvement and Regulation) Bill (NIA 7/02) be agreed.

In the chapter "Working For A Healthier People" in their first Programme for Government, the Executive made a commitment to put a framework in place to raise the quality of services provided to the community across health and personal social services. As the first step to fulfil that commitment, I presented my proposals entitled ‘Best Practice — Best Care’ for public consultation in April 2001. The responses to those proposals demonstrated widespread support for the introduction of new arrangements to underpin the quality of health and personal social services and to approve and extend the regulation of services.

The results of the consultation were published on 11 June 2002. On the same date, I announced my decisions on the main elements of a new framework designed to promote the quality of health and care services delivered here. The main elements of the framework can be summarised as follows: a system for developing new, or implementing existing, standards and guidelines; regulation of services to be extended to cover a much wider range of services; minimum care standards to be developed for regulated services; a statutory duty of quality to be introduced in health and personal social services; a system of clinical and social care governance to be introduced; a single independent regulation and inspection body — the health and social services regulation and improvement authority — to be established, with the twin roles of regulating services and inspecting governance within health and personal social services; service development frameworks, similar to national service frameworks in England, Scotland and Wales, to be developed or adapted for use here; and a performance management framework to be developed.

The Bill will give effect to the elements of the overall quality framework that require legislative backing. The Bill’s various provisions need to be considered in the context of the overall quality framework. It provides for a statutory duty of quality to apply to all health and personal social services bodies that deliver services. It establishes a health and social services regulation and improvement authority, which will be responsible for monitoring the quality of services delivered by the health and personal social services by reviewing clinical and social care governance arrangements within those services. It provides for the new regulation and improvement authority to be responsible for the regulation and inspection of an extended range of services.

Every year, hospitals here provide more than one million outpatient treatments. There are 500,000 admissions to hospitals or day procedure clinics every year. Every day, 30,000 people see a doctor or practice nurse, and 120,000 people will visit a community pharmacy. An average of 180,000 people contact social services every year. More than 20,000 elderly people are supported in their homes. The vast majority of people receive the quality of services that they require. Regrettably, however, some service users do not.

The challenge that the health and personal social services face is to guarantee a quality of service that the public can expect to receive, regardless of where they go for treatment or care and regardless of which organisation provides it. The many medical, professional and technological advances, and increased public expectation of the standards of services delivered, make it vital that health and personal social services modernise and improve in the future, to enable those services to deliver a fast and effective high-quality service. Part of the emphasis on quality agenda is on ensuring that services and treatments are delivered safely and that steps are taken to reduce risk and to avoid problems.

At present, many health and social care services, including those to children and vulnerable adults, are not subject to independent regulation and inspection. Regulated services are often not delivered according to common agreed standards, and that leads to unacceptable variations in the standard of care and treatment.

Publicity surrounding recent scandals in England, such as the Shipman case and the Bristol Royal Infirmary inquiry, combined with instances here, such as revelations about organ retention, and recent concerns about the storage of embryos and sperm samples, have shaken public confidence in our services. The introduction of a specific framework for clinical and social care governance will mark a major change for health and personal social services.

Governance arrangements are, of course, already in place to ensure overall probity, transparency and adherence to public service values. Clinical and social care governance, backed by a statutory duty of quality, will mean that, for the first time, health and social services boards and trusts will have to place the provision of high-quality services to the forefront of their statutory duties in the same way as they must adhere to statutory financial probity.

A framework for clinical social care governance will bring together all the existing activity relating to the delivery of high-quality services, including education and research, audit, risk management and complaints management. Many health and personal social services organisations have already begun to develop their own systems, based on systems elsewhere. The Bill’s intention is to ensure that a uniform set of principles will be applied to our unique organisational structures, and to take account of how services are delivered here.

Health and personal social services organisations will be accountable for continuously monitoring and improving the quality of their services, and safeguarding high standards of care and treatment. Organisations will take corporate responsibility for performance and for provision of the highest possible standard of clinical and social care. The new arrangements will build on and strengthen existing activity relating to the delivery of high-quality care and treatment, including audit activity; identifying, promoting and sharing good practice; risk assessment and risk management; quality standards; complaints management; clinical and social care effectiveness; evidence-based practice; research and education; and effective leadership and management.

To ensure independent monitoring of clinical and social care governance, a single body, the health and personal social services regulation and improvement authority, will be created. Its core functions will be to regulate and inspect services, provide advice, conduct reviews of clinical and social care governance arrangements, carry out systematic service reviews and undertake investigations. The new authority’s powers will, therefore, be wide ranging.

In addition to its regulatory function, the authority will take the lead in conducting reviews of clinical and social care governance arrangements. Through a rolling programme of local reviews of health and personal social services organisations, it will independently scrutinise the clinical and social care governance arrangements developed to support, promote and deliver high-quality services.

It will also help organisations to identify and tackle serious or persistent shortcomings in clinical or social care delivery, with the ultimate goal of supporting organisations in the delivery of high-quality, safe services. The authority will have a key role in providing users, the public, the Assembly and me, as Minister, with the assurance that systems are in place to ensure that the highest possible standards are adhered to and that the risk of something going wrong is greatly reduced.

Many initiatives are ongoing to promote continuous professional development through lifelong learning and strengthening professional regulation. My proposals will bring together those initiatives so that they can be managed and monitored in one framework for improving the quality of services.

Staff must also share ideas and good practice and take responsibility for the quality of services that they provide. Staff skills represent a significant investment that organisations must maintain by enabling employees to develop their skills and practice. A highly trained, competent and confident workforce is fundamental to securing the delivery of high-quality services.

A summary of the Bill’s provisions is in the explanatory and financial memorandum. The Bill is in five parts. Part I deals with the establishment of the new authority and its general responsibility. Part II covers regulatory procedures. Part III deals with the statutory duty of quality and the new body’s responsibilities. Part IV lists the new body’s functions. Part V deals with the authority’s powers of inspection and review and the departmental power to introduce minimum standards.

I want to hear Members’ views, and will, therefore, conclude my remarks. The Bill represents a radical agenda for the Executive, the Assembly, my Department and health and personal social services. Service users will benefit from the extension of regulation to cover a wider range of services, including those delivered to the most vulnerable users — the elderly and children.

Much work is being done on those arrangements that do not require legislative backing, and much work will need to be done in the future. It will take time to achieve all that we plan to achieve. I will try to answer as many Members’ points as I can at the end of the debate. If there is anything to which I am unable to respond today, I will write to the Member concerned. I commend the Bill to the Assembly.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party 11:30, 1 October 2002

I welcome the Bill. It follows through on proposals contained in the consultation document ‘Best Practice — Best Care’ to set clear standards for, and to improve the monitoring and regulation of, health and personal social services. I also welcome the Minister’s presence in the Chamber today.

There is an increasing and justifiable focus on how money is spent and on whether value-for-money services are being provided. That is a burning issue, especially for the Health Service, which has an annual budget of some £3 billion that accounts for some 40% of Northern Ireland’s block grant. The demographic trends in the preliminary census results that were published yesterday underline the increasing pressures that the Health Service will face in years to come. It underscores the need to test the effectiveness of the services provided by all Health Service bodies and to focus on areas in which performance can be improved.

The Bill’s aims are positive, but they must lead to the introduction of more economical and effective work practices, minimise bureaucracy and improve quality standards. It is imperative that the Minister take the necessary steps to demonstrate that limited resources are being deployed in the most effective and efficient way for the maximum benefit of the population. Patients who use the Health Service are entitled to expect quality care that is delivered consistently across board and trust boundaries.

I am glad that the legislation has been introduced to the Assembly. It will establish a new, independent body that will assume overall responsibility for the regulation of services and for the inspection and monitoring of the clinical and social care governance arrangements in health and personal social services. We have been told that it will cost £5·6 million a year to operate the body, which is £2·8 million more than at present. The Minister must demonstrate that that investment will provide a better regional service. She must convince the public that the new authority will not simply add another layer of bureaucracy, but that it will play a key role in ensuring that healthcare standards are being met and that the issue of clinical and social care governance is being addressed.

I welcome the establishment of clinical and social care governance. For many years, the teaching profession has been subject to inspections, and many of us can remember inspectors visiting schools. As someone who practised medicine in west Belfast for many years, I often wondered why teachers should have had to undergo inspections when doctors did not. I welcome the fact that all health professionals will be subject to clinical and social care governance.

The recent inquiry into the use of human organs highlights the clear need for the establishment of a watchdog to check that corporate organisations have best-care systems in place and are adopting the right practices. The Committee for Health, Social Services and Public Safety understands that the new authority will produce an annual report for the Department and will publish the results of its inspections. As always, much of the detail will lie in the Regulations that are to follow, which the Committee will scrutinise.

The Minister, as the authoriser of the new body’s work programme, must demonstrate clearly that her Department will hold the body to account. That is important. I am pleased that the Bill will give powers to the authority to assess the quality of some unregulated services that are provided by trusts, such as fostering and adoption. The Committee wants service provision in those areas to be improved to ease pressure on the children’s residential care sector. It is important that the statutory duty to deliver quality be applied equally to all services that are delivered by health and personal social services, whether they are provided by the statutory, voluntary or community sector.

The Bill does not set out a timetable for the regulation of services, which will undoubtedly depend on resources. The explanatory and financial memorandum indicates that the cost of running the new authority will lead to a net increase in expenditure of £2·8 million a year. Assumptions are made about the estimated income from the services to which regulation is extended. It is also pointed out that the level of fees has not been decided, and the minimum standards for the regulated services have not been developed. Extensive consultation on those matters is needed because they will directly impact on the minimum standards for healthcare providers such as nursing homes.

The Committee will focus its attention on the funding arrangements that the Department puts in place to support the Bill’s provisions. Those arrangements must ensure that the worthy aims of the legislation translate into genuine action to promote the quality of health and social care services, and that those aims do not founder because the necessary resources have not been committed. That is important. We do not want to be in a position in which, although proper minimum standards are set, staff cannot deliver them as a result of resource constraints. The Health Committee recently heard from Northern Ireland Public Service Alliance (NIPSA) officials of the deep frustration of social workers who cannot meet the quality standards set in respect of their statutory duties towards children. Although that is the case across Northern Ireland, it is especially so in the Foyle area, as we were recently informed by social workers. I trust that any resourcing gaps that are identified by the systems put in place to establish clear standards will be immediately addressed.

The introduction of a Bill that provides a framework to improve the quality of healthcare by establishing consistent minimum standards as well as establish a system of clinical and social care governance and improve monitoring and inspection, must be welcomed. My Committee Colleagues and I look forward to exploring the provisions of the Bill in detail at Committee Stage.

Photo of Sue Ramsey Sue Ramsey Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. In the previous debate, almost every Member touched on accountability and value for money in all Departments. I agree 100% with that, but it must happen across the board. That is why I was surprised at the attitude of some Members today to yesterday’s debate on the Rape Crisis and Sexual Abuse Centre. With that in mind, I welcome the Bill and agree with the Minister that it introduces a radical agenda. It aims to develop overall standards in the Health Service and secures local accountability for the delivery of services. Moreover, it will improve the monitoring and regulation of those services.

Like the Minister and the Chairperson of the Committee for Health, Social Services and Public Safety, I welcome the proposal to establish a single health and social services regulation and improvements authority. Trusts and boards will have a statutory obligation towards equality, and, during the Bill’s Committee Stage, I intend to ask officials exactly how that will be introduced and whether there will be sanctions against the chief executives of trusts that fail to meet that obligation. The Bill’s impact will be beneficial for clients, service users and Health Service personnel. It should end the postcode lottery that can exist with quality care and that Members have referred to time and time again. The Bill will have a positive effect on protecting the rights of vulnerable people, whether in children’s homes or in homes for the elderly.

I also welcome the legislation and look forward to its Committee Stage.

Photo of Kieran McCarthy Kieran McCarthy Alliance

Alliance supports the Bill to establish an authority to oversee the delivery of services by health and personal social services, as well as by our independent and voluntary private sectors. The Bill will go far towards achieving the goal of securing local accountability for the delivery of services and will improve their monitoring and regulation.

The Bill closes a variety of loopholes. Previously, some health and social services were exempt, for one reason or another, from proper regulation. For example, wholly private GP call-out services will be included in the regulatory framework as will private primary-care practices.

The House will not be surprised to hear of my particular interest in the section of the Bill that deals with personal care. I endorse the inclusion of residential care homes in the proposed regulatory scheme. I am pleased that the Department of Health, Social Services and Public Safety considered the 1999 report of the Royal Commission on Long Term Care for the Elderly.

Personal care is defined in the Bill as:

"(a) action taken to promote rehabilitation;

(b) assistance with physical or social needs; and

(c) counselling".

Such assistance can include help with bathing, toileting, dressing and eating for people who cannot perform those tasks for themselves. The Bill recognises the distinction between the services provided in residential care homes and in nursing homes, and that is incorporated in the Bill.

Furthermore, I welcome the fact that domiciliary care agencies are to be included in the proposed regulatory schemes. Domiciliary care agencies provide vital services for people in their homes. Given the significance of personal care that is recognised in the Bill, and the services provided by nursing homes, why can the House not vote at an early date to provide personal care on the same terms as nursing care?

Nevertheless, I welcome the Bill. That such a breadth of health and social services is being amalgamated in a singular, regulatory framework will help everyone involved to deliver the best possible care and practice.

For the Alliance Party and for me, the recognition of personal care only serves to underline its significance in our society. If the Bill is passed, I shall continue to campaign for free personal care in the new regulatory scheme. The Alliance Party fully supports the Bill.

Photo of Bairbre de Brún Bairbre de Brún Sinn Féin

I thank Members for their attention to the detail of the Bill and their warm welcome to its provisions. Several Members who spoke referred to the added value that will result from the establishment of the new authority, which will provide an independent check of the quality of the services delivered by the health and personal social services (HPSS) and the independent sector.

The new authority will provide service users with greater safeguards on the services that they receive; reduce inequalities and improve equity by ensuring that services are delivered consistently across the North to meet the same minimum standards, regardless of where people live and whether services are delivered by the HPSS or the independent sector; and ensure that systems are in place to address poor performance. Therefore, it will also help to reduce the clinical negligence bill, which is an important factor for Members.

The new authority will mean that, for the first time, the quality of services provided by HPSS will be independently monitored against agreed minimum quality standards. To ensure that effective clinical and social care governance arrangements are in place, the new authority will regulate more of the services delivered to children and vulnerable adults, including some that are provided by HPSS.

Providers will not be able to register those services that are to be regulated unless they meet minimum standards, and failure to register will mean that providers may not legally continue to provide those services. The new authority will also review the quality of, and access to, services across the North.

Between 1991 and 2001, £55 million was paid in compensation for clinical negligence. It is to be hoped that the work of the new authority will reduce that amount. Its work will also ensure that people have the assurance of minimum standards against which all services will be judged.

Several Members referred to the Regulations. I agree that further work will arise, and I look forward to hearing the points that Colleagues raise during Committee Stage. It is to be hoped that I shall be able to provide further assurance then. Once the Bill’s principal Regulations have been drafted, we shall consult on them before they are laid before the House.

I hope that I have dealt with Members’ main points. As I said, I shall try to deal in writing with any points that I have not covered. I shall ask officials to look at the record, and I look forward to working with the Committee on the Bill.

Question put and agreed to.


That the Second Stage of the Health and Personal Social Services (Quality, Improvement and Regulation) Bill (NIA 7/02) be agreed.