Improvement programme for Northern Irish health & social care

Health Minister Edwin Poots has announced a programme of actions to promote quality and good governance across Health and Social Care (HSC) in Northern Ireland.

Speaking in the NI Assembly, Mr Poots set out his strategic approach to promoting quality and good governance and outlined the measures currently being implemented. The move comes after it emerged there had been failings in the quality of care and governance at both the Belfast and Northern Health and Social Care Trusts.

During a comprehensive statement, the Minister informed the Assembly:

• His intention to commission former Chief Medical Officer of England, Professor Sir Liam Donaldson, to advise him on improvement on governance arrangements across the HSC. Sir Liam will investigate whether an improvement in the quality of governance arrangements is needed and whether the current arrangements support a culture of openness, learning and making amends.

• The commissioning of the Regulation and Quality Improvement Authority (RQIA) to undertake a rolling programme of inspections of acute hospitals focussing on a range of quality indicators including triage, assessment, care, monitoring and discharge.

• The progress being made by the RQIA Team reviewing Emergency Departments (EDs) across Northern Ireland.

• The College of Emergency Medicine (CEM) Summit on Unscheduled Care, taking place tomorrow, which will bring together senior staff representatives from Hospital Medicine, General Practice, Nursing, Social Work, Allied Health Professionals, Health Management and Trade Unions to share learning and to provide definite proposals to complement the work of the RQIA Review Team.

• The Quality Improvement Plan – a detailed action plan – from the Belfast Trust in response to the RQIA Inspection Report into the ED and the Acute Medical Unit (AMU) at the Royal Victoria Hospital which is published today. The Trust has provided assurances that its Quality Improvement Plan will fully address the findings and recommendations in the RQIA Inspection report.

• Update on the actions being taken by the Belfast Trust – announced in his statement on 18 March – including the appointment of 40 nurses; the appointment of an Associate Director of Nursing for Unscheduled Care and an ED lead for Safety and Clinical Governance; enhanced cleaning services, additional catering provision; improved portering services and security; and opening of a new ward in Belfast City Hospital.

• Assurances he has received from the Northern Trust that appropriate actions have been taken, including engaging with patients and families, around the 20 Serious Adverse Incidents (SAIs) where care was below the standard expected.

• The phased regional implementation of the Mortality and Morbidity Review System (M&MRS) – an enhanced assurance process for all deaths in hospitals. Rolled out over three years, it will record, review, monitor and analyse all hospital deaths providing additional scrutiny of the Death Certification process. It will also enhance a culture of learning; improve SAI reporting; provide an additional safeguard to ensure that deaths are appropriately reported to the Coroner; and improve the quality of information provided.

• His instructions to all Trusts to review all SAI reports of incidents between 2009 and 2013 and provide: information covering engagement with families; in cases of deaths, assurance of compliance with the statutory duty to inform the Coroner; assurance of appropriate escalation; and details of general or specific issues not previously identified.

• As part of a planned review of adverse incident management, the RQIA will independently investigate and quality assure the work each Trust has taken as part of this exercise.

• An update on the look-back of ED-related SAI investigations 2009-2013 announced in February, which he expects to be completed by next month.

Mr Poots said that there have been serious failings in the quality of care provided to patients and the robustness of governance arrangements in both the Belfast and Northern Trusts. Before outlining the actions he is taking to address these specific problems, he outlined the key elements of his strategic approach to improving quality of care and robustness of governance.

The Minister said: “My approach in responding to those failings has been to find out what went wrong and to ensure action is taken to correct it, as these are serious matters and deeply concerning for those patients and their families. I wanted to establish the facts and to take immediate, medium term and longer-term action to correct what went wrong and to ensure that the necessary learning would be applied across the entire Health and Social Care system.”

In outlining the content of the RQIA Inspection Report on the ED and AMU at the Royal Victoria Hospital, carried on the weekend of 31 January and published today, the Minister said: “Despite the failings identified, one clear message shines through, and that is the commitment of the staff to their patients – staff who are genuinely upset whenever they feel they have not, for reasons outside of their control, been allowed to give the best care to their patients. These are doctors and nurses, social workers and many other health professionals, porters and domestic staff and managers who are making enormous effort to ensure that the sickest and most vulnerable people are given priority and patient safety protected. My thanks and appreciation goes out to them all. The challenges are complex and some of the solutions will not be immediately deliverable.”

He reminded members that when he made his Statement to the Assembly on 10 February he outlined the RQIA’s interim findings from its inspection. He said that these interim findings are now fully reflected in the report published today.

He added: “I was deeply upset to hear of suggestions that dignity is not always afforded to those who die in our emergency departments. This cannot continue and must change. I was angry that people had experienced unacceptable levels of care, I was angry that staff did not feel supported in delivering the care they wish to, and I was particularly angry at the suggestion that targets should come before patients. This is unacceptable and I cannot and will not tolerate it.”

He told Members of the Legislative Assembly (MLAs) that it was in response to the findings of this report he had asked the RQIA to secure from the Belfast Trust a detailed action plan setting out how they will address the failings and issues identified. That action plan, in the form of a ‘Quality Improvement Plan’, is included within the RQIA’s report and describes how the Trust is addressing all of the recommendations in the report.

On the commissioning of work from Sir Liam Donaldson, Mr Poots said he wanted to see if a marked improvement in the quality of governance across the HSC is needed to support a culture of openness, learning and making amends.

He said: “I am commissioning external experts who have a high-level of expertise in the field to undertake a study to provide me with independent advice on the effectiveness of governance arrangements and how they can be further developed and strengthened. An initial approach has been made to Professor Sir Liam Donaldson and he has indicated that he would be willing to take up this assignment. Sir Liam has extensive experience in healthcare. Terms of reference for his piece of work, which I expect will be completed by the autumn, are in the currently being finalised.”

In conclusion, the Minister said: “I am committed to ensuring that the quality of care provided to patients coupled with the corporate governance that underpins care is the best it can be and to ensure that we have a mindset across the HSC that will deliver this.

“All of the action that I have taken in recent weeks and the further actions that I have announced today are designed to give assurance that the provision of high quality care and robust systems and procedures are the routine day-to-day business of the HSC and when failings do occur these are quickly identified and rectified with openness and transparency. I believe that the facts to be established by the reviews to report later this year will confirm this to be the case, however, I also want to ensure that we learn from recent experience and refocus or redirect our efforts where necessary.

“I am confident that the strategic building blocks that I have put in place will deliver over time a step change improvement in the quality of care provided to patients and the quality of governance arrangements across health and social care in Northern Ireland.”