RQIA Resignations

Question for Urgent Oral Answer — Health – in the Northern Ireland Assembly at 3:30 pm on 23 June 2020.

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Photo of Roy Beggs Roy Beggs UUP 3:30, 23 June 2020

Colin McGrath has given notice of a question for urgent oral answer to the Minister of Health. I remind Members that if they wish to ask a question, they should indicate so by rising in their place continually. The Member who tabled the question will be afforded an opportunity to ask a supplementary question.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

Mr McGrath asked the Minister of Health, given the recent change of management personnel in the organisation and the resignation of all the non-executive directors, for his assessment of the capacity of the Regulation and Quality Improvement Authority (RQIA) to undertake its work and fulfil its statutory duty in the midst of the COVID-19 pandemic.

Photo of Robin Swann Robin Swann UUP

With your indulgence, Mr Deputy Speaker, I ask for an extra minute to give my answer.

I am confident that the changes to RQIA's management personnel and board membership will have no impact on the organisation's day-to-day work. Let me make it clear that I continue to have total confidence in the staff who work in the organisation. I am grateful to those staff for their continued commitment to delivering on RQIA's priorities because this has been an unprecedented time and the organisation's staff have worked tirelessly and consistently with colleagues across health and social care (HSC) as an integral part of the regional response to support services during the COVID-19 pandemic.

Following the receipt of a request from the Department, and in response to an urgent need for support across the HSC, RQIA significantly reduced its inspection activity and review programme. That temporary measure was introduced in order to, understandably, minimise the risk of health and social care professionals and other visitors spreading infection in care homes. I remind the House that similar decisions were taken in England, Scotland, Wales and the Republic of Ireland.

The resignation of the board members is regrettable, especially coming at this incredibly challenging time. That is why, within hours of the former board members resigning, I moved quickly to appoint Christine Collins MBE as the new interim chair. I am confident that Christine will further strengthen the voice of people who use the health and social care system; something that I am very keen to see. As I said last week, I have asked officials to consider how, going forward, we might further strengthen the voice of people who use services in the field of regulation, quality and improvement, in keeping with our approach to co-production and partnership working.

In the light of the move to rebuild HSC services across Northern Ireland, and with community transmission of COVID-19 now significantly reduced, the Chief Medical Officer has written to RQIA seeking to enable it to increase its activity across all areas of work. RQIA has developed a revised, flexible inspection process that it intends to implement from July 2020, following engagement with providers and trusts. I am confident that RQIA will continue to take a pragmatic and flexible approach to how and when inspections take place and will endeavour to meet the statutory minimum requirements where possible. In the immediate time, it is important that RQIA focuses its activity where it is most needed, following an assessment of all the risks.

I have today asked David Nicholl of On Board Training to undertake a review of the circumstances that gave rise to the recent events in RQIA. David has a wealth of experience in this area and is a highly respected independent figure, and I look forward to receiving his objective analysis of the position.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I thank the Minister for coming today to address this urgent matter and for his response to my question, which has at its core the protection of our vulnerable and elderly relatives.

It would appear that the management of RQIA was systematically dismantled in the middle of a global pandemic, without the consent of its board. Was this the sensible thing to do, Minister, given that our care home sector is on the front line of the pandemic? Who took these decisions, and do you stand over them?

Photo of Robin Swann Robin Swann UUP

I thank the Member for bringing the matter to the House, because I think that it is something that needed to be addressed, not just publicly but in the Chamber.

With regard to the management changes that we made in the teeth of the COVID-19 pandemic, Members should always remember that this was just a few months ago, when we were looking at scenes across western Europe and in Italy where people were lying in hospital corridors waiting for treatment. In changes of management, the RQIA's chief executive, Olive Macleod, has actually taken up a temporary post within the Public Health Agency (PHA), which is another front-line part of our fight against COVID-19. Dermot Parsons, previously the director of assurance, has been appointed as the interim chief executive of RQIA, and Emer Hopkins, previously the deputy director, has taken up post as interim director of improvement. So it is not a completely new management team. We took Olive out to place her in the PHA at a time when we needed to strengthen what the PHA was doing with regard to test and trace and our entire system there. We used her expertise, and Dermot and Emer were promoted internally to retain the collective knowledge and management experience within RQIA.

Photo of Colm Gildernew Colm Gildernew Sinn Féin

Given the quite unprecedented nature of the en masse resignation of the board, does the Minister accept that the Department's actions have called into question the independence of RQIA?

Photo of Robin Swann Robin Swann UUP

I do not think so. I think that there are difficulties in relationships, which the independent inquiry that I have asked David Nicholl to take forward may tease out. I was made aware of tensions between the board and the executive management of RQIA at the start, while we were actually working through our response to the pandemic. Those tensions will be teased out and worked out, but I do not think that the independence of RQIA has been affected at all. The reaction, now that we have stood up inspections again as from yesterday, will actually strengthen that input as to how we manage the care home sector in the next few months and make sure that it is prepared for any second surge, should that occur.

Photo of Pam Cameron Pam Cameron DUP

I thank the Minister for the opportunity to ask some questions on the subject. With hindsight, does the Minister accept that the Department's focus on minimising the risk of health and social care professionals from RQIA spreading infection within care homes was disproportionate, given the rapid spread of the virus in those homes at the height of the first wave?

Photo of Robin Swann Robin Swann UUP

As I said in my earlier statement as well, the steps that were taken with regard to repurposing RQIA were the same steps that were taken in England, Scotland, Wales and the Republic of Ireland. It was not about stopping inspection or stepping it back. It was about a reduced inspection process, but it was also about utilising the professional talents and capacities of those people working within RQIA — social care workers, nurses and healthcare professionals — that we can actually put in place to support care homes with regard to infection control, the use of PPE and how they actually supported residents as well. It was about repurposing a cohort of highly qualified and reliable staff, who knew the sector, to aid us in the response and how we tackled COVID-19.

Photo of Sinéad Bradley Sinéad Bradley Social Democratic and Labour Party

Minister, given the critical need for a regulatory body at this time, can you outline how long you anticipate it to take for a new board to come together? Are you planning any interim measures that could, perhaps, bridge the gap until a full board can be put in place?

Photo of Robin Swann Robin Swann UUP

That is a critical point. As I said, that is why I moved at haste to appoint Christine Collins, the current chair of the Patient and Client Council. She comes with experience, not just of the health sector but of chairing a board.

To clarify the point, I wrote to the Office of the Commissioner for Public Appointments for Northern Ireland on Thursday 18 June to inform her that, on the 17 and 18 June, the active non-executive chair and five non-elected board members had resigned. So I have already engaged with the Commissioner for Public Appointments. That process will now start, and I hope to have a full board in place by the end of July.

Photo of Steve Aiken Steve Aiken UUP

I thank the Minister for his response so far and for his swift response in setting up the independent investigation into the RQIA. However, can the Minister ensure that the terms of reference cover why the recent board of the RQIA did not action the many recommendations from previous investigatory reports and, particularly, those from the Care Inspectorate and the Commissioner for Older People?

Photo of Robin Swann Robin Swann UUP

When looking at the terms of reference and what to ask David Nicholl to do, I would rather concentrate on this specific issue. I am aware that the Commissioner for Older People has raised a number of concerns around outstanding pieces of work that the RQIA were undertaking and are due to undertake. In the initial steps, I will ask David to look at this specific focus because I cannot afford to distract the current staff of the RQIA as we move back into the inspection phase that they are tasked and empowered to do.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Minister, in your press statement, from the last 24 hours, you said that you wished that the board members had approached you and raised the issues so that you could have resolved them. We now know that emails were coming forward from the former chair and the interim chief executive to your Chief Medical Officer and permanent secretary as far back as the end of April. When did you become aware, and what have you done, to try and resolve the issues?

Photo of Robin Swann Robin Swann UUP

I was made aware in early May that there were tensions between the executive and the board of the RQIA. I was not aware that it was to the extent that it was, neither was the Chief Medical Officer or the permanent secretary. When the resignations came through, they came as a surprise. I was due, that afternoon, to meet with the chairs of all the arm's-length bodies, including the chair of the RQIA. She resigned on the morning that I was due to meet her. That was actually in the diary and ready to happen but, unfortunately, events overtook that being possible.

Photo of Alex Easton Alex Easton DUP

I thank the Minister for his answers so far. Will the Minister give us a guarantee that the RQIA will be able to function properly after these resignations?

Photo of Robin Swann Robin Swann UUP

I can. I made it clear, in my statement earlier, that the staff of the RQIA are still doing the functions that they are meant to do; they are still doing that very well as a group of highly professional individuals who are tasked with the regulatory inspection side of our care homes and our health system. I am confident that they will perform the tasks that are part of their duty and role. I am also reassured that the oversight function is there as well, with the appointment of Christine Collins as the interim chair of the board until we get a full board in place.

Photo of Pat Sheehan Pat Sheehan Sinn Féin

Go raibh maith agat, a Leas-Cheann Comhairle, agus gabhaim buíochas leis an Aire as ucht a ráitis. I thank the Minister for his statement. Given the fact that there has been a serious number of scandals in our care sector over the last number of years, particularly in Dunmurry Manor and Ashbrook, and the fact that so many residents in the care sector have died during the pandemic, what will the Minister do to ensure that a proper regulatory authority is there, in the time ahead?

Photo of Robin Swann Robin Swann UUP 3:45, 23 June 2020

The Member makes a valid point, and it is something that I have raised in previous statements. We need a root-and-branch review of what RQIA and the body does. We have restricted them in the legislation of the inspections that they could carry out, and there is an expectation that the inspectors with RQIA should look at more than they do. That is why the appointment of Christine Collins, who is coming from the Patient and Client Council, is important. I said in my statement that it is crucial that, in the appointment of the next board, we make sure that there are people on that board who have the lived experience and have the patient input, so that the board reflects wider society and those who rely on RQIA carrying out its inspections.

Photo of Joanne Bunting Joanne Bunting DUP

In light of the high-profile resignations from the board, what immediate steps will the Minister take to ensure that there is community and public confidence in the work of RQIA at this critical time for safety, support and care for those living and working in our residential care homes?

Photo of Robin Swann Robin Swann UUP

I thank the Member because she makes an important point. All those who have loved ones in care homes have been through a trying time over the past 14 weeks, when they have not had visiting access or been able to get in to see their loved ones. There is a reliance on the staff of the care homes and those inspectors. Inspectors from RQIA will now engage again with care home facilities to make sure that that reliance and reassurance is there.

With regard to reassurance, as, I think, I said in my statement, in the appointment of the interim chair with her experience from the Patient and Client Council, I hope that there is more of a merging of the thought process and a synergy of the two organisations that can increase the patient voice and input into what RQIA does.

Photo of Alan Chambers Alan Chambers UUP

Given the fact that similar decisions have been taken across the United Kingdom, does the Minister consider that the operational decision to reduce the number of routine inspections of care homes in March, which was designed to reduce the disruption of routines in homes and to curtail the introduction of the virus into care homes, and the decision to redeploy staff involved to other more pressing duties around the pandemic were justified and the appropriate thing to do in the circumstances at the time?

Photo of Robin Swann Robin Swann UUP

I refer the Member to a previous answer, when I said that staff of RQIA were being redeployed and repurposed to support the care home sector and their residents and to provide their professional

[Inaudible]

should it be social workers, the nurses or even the pharmacists who were part of the RQIA inspection team. It is about enabling them to get into homes as part of the physical support that we were giving to care home workers, the management and the residents.

As the Member will be aware and as I referred to in my statement, what we did in March was in the teeth of the pandemic of COVID-19. We were seeing it spread not just across the United Kingdom but across western Europe and the world. The decision that was taken at that time was the same as the decision that was taken in England, Scotland, Wales and the Republic of Ireland.

Photo of Rachel Woods Rachel Woods Green

I thank the Member for asking the urgent oral question. The Commissioner for Older People has rightly described the resignations of the board as a worrying development. This morning, he said that the circumstances surrounding the resignations were a mess and that this could not have come at a worse time. Does the Minister agree that independence is vital to provide proper scrutiny? Did the Department undermine RQIA's independence, and does he think that RQIA should be given greater statutory independence in order to better fulfil its functions?

Photo of Robin Swann Robin Swann UUP

I thank the Member for her comment. I also noticed that the Commissioner for Older People said this morning:

"A new board must grasp the reform needed as a matter of urgency to ensure that we get a system of regulation and improvement that tackles the underperfomance of providers swiftly and robustly so that older are better protected now and in the future".

I fully concur with what Eddie Lynch said this morning, because that is the direction of travel that I am going in as Minister.

With regard to the independence of the RQIA as an inspectorate, I am keen to reinforce that. It is already there in legislation, but, as I said earlier, it is also about bringing the patient/user experience into that inspection and quality process. That has maybe been missing in the past. When you engage with some of the families — Mr Sheehan referred to previous reports — and look at the findings and outworkings of many of those, the feedback was that there was a lack of family and user input. When we reconstitute a new board — I intend to do that — I hope that those voices are heard, to provide not just independence but insight into that lived experience.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

Knowing that he was coming to the House this afternoon, why did the Minister choose to announce the investigation by Mr Nicholl at a press conference, rather than to the House, given what some previous Speaker's rulings have said about the importance of Ministers giving the House its place?

When the board members resigned, they said that they had done so because of decisions taken by the Department into which they were given no input: is that correct? If so, does that suggest a degree of overbearance and interference by the Department that calls into question the perceived independence of the regulator?

Photo of Robin Swann Robin Swann UUP

I assure the Member that no disrespect was meant to the House or anybody in it in the announcement of the inquiry. I have given the Executive press conference every Tuesday over the past two or three months. Today, I was asked and made a statement about what would be coming in regard to appointing David Nicholl to complete the inquiry. The issue has received much press coverage this morning, and many Members have made statements about what they were going to tell me today when I came to the House. When a member of the press asked me, I responded and made a statement. I apologise to the House for that, but I am here to answer a question for urgent oral answer and will speak shortly in a mental health debate, so, Mr Allister, time did not allow me to do anything different. The Member knows that I have great respect for the House and its Members.

With regard to the timing of the decisions that were taken on the repurposing of the RQIA and the inspectorate, it was a direction from my Department so that we were able to repurpose those members of staff in the RQIA and make sure that we reacted promptly and accurately to support those in care homes who needed that support. We did that by reducing the number of inspections that the RQIA was able to conduct. How many inspections the RQIA can carry out per year is mandated in legislation, so it required a change in legislation. My Department was mandated to do that to allow it to facilitate that operation.

Photo of Gerry Carroll Gerry Carroll People Before Profit Alliance

I thank the Member for asking the question for urgent oral answer. Minister, does the resignation of the entire board of the RQIA, which oversees the handling of care homes, represent a damning indictment of your and previous Ministers' approaches to the handling of care homes?

Photo of Robin Swann Robin Swann UUP

Since taking up my post on 11 January, my support for care homes has been expressed and demonstrated through the financial support that I have provided and the repurposing of trust and RQIA staff to go in and support the care homes. Through our interactions on the Committee, the Member will know well how I see and prioritise our care sector and its place in the health and social care family. I value it. During one of the engagements that we had with the Health Committee, I referred to the care sector as the "Cinderella service" of our healthcare profession and one that has long gone unrecognised and unrewarded. That is something that I, as Minister, want to change. I want to bring recommendations to the Executive on how we can further support our care sector and the people who work in it, who are often working at if not below minimum wage with the way that their hours work. I aim to make sure that those who work in that sector are valued and recognised.

Photo of Mervyn Storey Mervyn Storey DUP

I thank the Minister for coming to the House. His last comment may be a personal comment on how care homes are valued in society. I wonder whether that goes across the higher echelons of the Department, particularly as we look at any reorganised inspection regime. Can the Minister provide assurance that the resumption of statutory and non-statutory inspections will be carried out in a safe, coordinated and care-centred way and in a timely manner? It is extremely sad that, yet again, in the midst of these circumstances, care homes are at the centre of the story. I know your personal concern about that, but we need clarity about what the Department knew and what it did or did not do.

Photo of Robin Swann Robin Swann UUP

I thank the Member for raising that point, because, for me, as Minister, it is a personal issue. I feel that every Minister should bring to their portfolio their understanding of and support for those working in their area and those who rely on it.

As regards what the Department knew, when it knew it and how it reacted, I fully intend to empower David Nicholl to bring all that to the fore so that it will be put in the public domain so that Members and those who rely on the services provided by RQIA get the full picture not just from the board members who resigned but from the staff and senior management team in the RQIA, who were on the other side of what is now, I suppose, a public debate. I hope that, today, I can bring some reassurance to those who rely on and those who work for RQIA that the Department and its Minister are doing all that they can to make sure that those who rely on the service get the support that they need.

Photo of Mike Nesbitt Mike Nesbitt UUP

I would be grateful if the Minister would correct me if I am wrong in my summary of what I hear in this session, which is that the reduction in inspections was common to all neighbouring jurisdictions, that there was no systemic dismantling of the management of RQIA, that the Minister has full confidence in the staff and executive management of the RQIA and that he anticipates that the new board will be more effective than the old one, pending a departmental review of arm's-length bodies.

Photo of Robin Swann Robin Swann UUP

The Member has summarised the full discussion that has taken place in response to the question for urgent oral answer. I do not think that there is anything in what the Member said that anyone in the House could disagree with. We rely on RQIA to provide a service that reassures, reinforces and provides comfort to families who have loved ones residing in care homes.

Photo of Paul Frew Paul Frew DUP

I welcome the Minister's presence today to answer the question. Given the repurposing and the restrictions on inspections, what consideration was given to adult safeguarding policies, particularly around the risk assessment of individuals and the retention of information possibly required for criminal investigations? What alternative was activated to ensure that risk assessments were undertaken?

Photo of Robin Swann Robin Swann UUP

The repurposing of individuals was necessary at that time. The Member has asked a detailed question, and I will get back to him in writing with as detailed an answer. I could give him a high-level briefing from the notes in my folder today, but I do not think that it would do his question justice. There is, I suppose, a greater need for the detail that he is asking for, and I would rather provide it in a written response than try to answer verbally.

Photo of Roy Beggs Roy Beggs UUP

That is the end of questions to the Minister on the question for urgent oral answer. I ask Members to take their ease for a few moments, until the Temporary Speaker takes the Chair for the continuation of questions on the Education Minister's statement.

(The Temporary Speaker [Mr G Kelly] in the Chair)