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									QUALITY
Making a difference
- a view from the Chief Executive
I am delighted about my
appointment as the first Chief Executive of the HPSS Regulation and Improvement Authority. The Authority will have a huge remit once it takes on all its responsibilities. It must ensure standards are met; ensure the availability and accessability of services – particularly for the vulnerable; and must investigate and report publically where there are deficiencies. In short, it must contribute to improvements in quality. In doing so, the Authority must conduct its affairs fairly and manage its resources effectively so as to earn the trust of those who provide health and social care in Northern Ireland and the public they (and the Authority) serve. Initially, I will be concentrating a lot of my energy on those processes and procedures that need to be put in place to allow the Authority to function on a phased basis from 1 April 2005. In particular I want to ensure that the transfer of staff from the Boards’ Registration and Inspection Units to the new Authority is done as seamlessly as possible. Change can be a difficult and I want to ensure that the move is a positive experience for all involved. I will wish to build upon the foundations of their knowledge and experience in taking forward the Authority’s wider regulatory duties. I will also want to accentuate from the outset the positive influence that I believe the Authority can play as it seeks assurances from its partner organisations in the HPSS that appropriate arrangements are in place to improve the quality of services and increase the safety of service users.The Authority will wish to promote continuous improvement. Regulation should not be seen merely as a policing tool, but more a

update

Issue No 2 - Winter 2004

Better health and social care in Northern Ireland Quality update is produced by the Department of Health, Social Services and Public Safety. It aims to provide an update on developments in the agenda for improving health and social services.

Mrs Stella Burnside Chief Executive of HPSS Regulation & Improvement Authority.

recognition or certification that improvement and quality are embedded at all levels of an organisation or service. In carrying out our work it will be my aim and that of my colleagues to ensure that the Authority really does make a qualitative difference in improving the care provided in Northern Ireland.

BOARD MEMBERS APPOINTED TO NEW AUTHORITY
The first six non-executive board members of the HPSS Regulation & Improvement Authority were appointed on the 6th December 2004. The new members are Dr Richard Adams, Mrs Lillian Jennett, Dr Conor Mulholland, Mr Allen McCartney, Mr Austin Smith and Mr Colin Reid. The appointments, each for a term of four years, will take effect from 1 January 2005.

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Four into one will go … but still a job to be done!
Currently around 37
registration and inspection staff and 19 administrative support staff work for the four HSS Board Registration and Inspection Units.They inspect some 680 registered establishments in Northern Ireland, involving around 1,500 inspections annually of nursing, residential and children’s homes including inspections of non–registered facilities such as laser treatment and Boarding Schools. The Units are responsible for ensuring that legal requirements for registration and inspection are followed; that advice and guidance is provided as necessary; that good quality care is provided; and that best practice is promoted and encouraged. From 1st April 2005, the new HPSS Regulation and Improvement Authority will assume responsibility for registration and inspection. On this date, Registration and Inspection Unit staff will transfer to the new Authority. Decisions remain to be taken on how many offices the new Authority will need. In the meantime, staff tansferring to the new Authority will remain on their present sites. HQ offices will be located in the Belfast area in the short term to accommodate the offices of the Chairman and Board, and Senior Management Team of the Authority. Discussions are taking place with the Registration and Inspection staff, their Union representatives, HSS Boards as current employers and HPSSRIA on the detailed arrangements involved in the transfer. “Change and uncertainty are always unsettling” says Malcolm Allen, Head of R&I Unit, EHSSB, “but inspection staff and their administrative support will continue to ensure that care services are up to standard and that the move to the new arrangements are as smooth as possible.”
Left to right EHSSB – Unit Head – Mr Malcom Allen; NHSSB – Unit Head - Mrs Julie Thornton; WHSSB - Mrs Josie Fee – Unit Head; SHSSB - Ms Muriel Dickson – Unit Head.

Have you had your say on new care standards?
Public consultation on Tranche 1 of new care standards for regulated services closed on 20th December following a series of information events held across Northern Ireland. A summary of the comments received by the Department will be published in due course. These comments will inform the final versions of the standards for Tranche 1 services – homes, domiciliary care agencies, fostering agencies, nursing agencies and services for children under 12. Consultation on the second tranche of standards – covering day care centres, independent health care and residential family centres – closes on 11th February 2005. The standards are available for comment on the DHSSPS website at http://www.dhsspsni.gov.uk/econsulta tion/index.asp . The third and final tranche of Care Standards will be released for public consultation shortly and will cover standards for adoption agencies, boarding schools and adult placement agencies. Further information on the Care Standards consultation can be obtained from the Standards & Guidelines Unit, D1 Castle Buildings, Stormont Estate, Belfast BT4 3SQ. Telephone: 028 90 522028. Email: standards.consultation@dhsspsni.gov.uk

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Top NHS award for the Nothern Ireland Medicines Governance Project
The Northern Ireland Medicines Governance Team has beaten off strong
competition from around the UK to scoop a top prize in the 2004 Health Service Journal Awards. The award was presented on 15th November at a special ceremony in London, in the presence of Minister of State for Health, Rosie Winterton, and Health Secretary John Reid. “This honour recognises the team’s outstanding work in the field of patient safety” said Norman Morrow, Chief Pharmaceutical Officer for DHSSPS. “The judges considered that the principles of reporting, analysis, solution development and action to disseminate made this an excellent project”. It was chosen as the winner from 33 entries in the category because it made good use of data,
Representatives from the NI Medicines Governance Team receive their award. From left: Natasha Kaplinsky (BBC Breakfast News), Dr Norman Morrow (Chief Pharmaceutical Officer, DHSSPS) ,Tracey Boyce (Medicines Governance Team Leader) and Sue Williams (Joint Chief Executive, National Patient Safety Agency)

involved patients and was evidence based and multidisciplinary. The team was set up to minimise medication-related risk in Northern Ireland’s hospitals by promoting the application of risk-management principles to medication use in a coordinated and consistent manner across the region. It encompasses a team of six senior pharmacists and an administrative assistant dedicated to increasing levels of reporting of medication incidents, managing incident data, developing and implementing risk reduction strategies and providing medication safety

education for staff. The team’s survey of clinical staff in 12 Trusts uncovered the true barriers to the reporting of medication incidents. The team then ran a series of educational presentations to address these issues, to promote the open reporting of medication incidents and to explain the importance of ‘near-miss’ reporting in ensuring patient safety. This approach has resulted in a tenfold increase in the number of medication incident reports received.

Essence of Care – Better services in key aspects of care
The Department is
working with the Northern Ireland Practice Education Council on the Northern Ireland Essence of Care Project which aims to improve patient experience in areas of fundamental importance to the quality of care. These include • • • • • • Continence, bladder and bowel care Personal and Oral Hygiene Food and Nutrition Treatment of Pressure Ulcers Privacy and Dignity Record Keeping with input from over 2000 patients, professionals and user group representatives in England.They have relevance for care regardless of where it is delivered – acute, community, statutory, voluntary or independent sector. “Benchmarking helps practitioners take a structured approach to sharing and comparing practice” says Nikki Patterson, Nursing Officer, DHSSPS. “This helps them to identify best practice and develop action plans to remedy poor practice.” The Northern Ireland project is testing the benchmarks in a variety of sectors and is encouraging benchmarking between organizations as well as within them. Quality Update Page 3 Essence of Care has been designed to support measures to improve quality and has clear links to the emerging Clinical and Social Care Governance arrangements both locally and regionally within Northern Ireland. There are currently 16 HSS Trusts, 6 Nursing Homes, Northern Ireland Prison Service, and the Marie Curie Centre involved in the Project. Further information about the project is available from Suzanne O’Boyle, Project Officer. NIPEC Centre House 79 Chichester Street, Belfast 02890 238152 Suzanne.oboyle@nipec.n-i.nhs.uk

The Project is testing the Department of Health "Essence of Care" benchmark standards for applicability in Northern Ireland.The original benchmarks were developed

National Clinical Assessment Authority now covers Northern Ireland
The Department and the National Clinical Assessment Authority
entered into an agreement that extended the remit of the Authority to cover Northern Ireland from 1st October 2004. “The Authority is at the centre of a co-ordinated approach to improve patient safety and provide a supportive environment for doctors and dentists.” Dr Paddy Woods explains that under the new agreement “It will now be able to support the Health and Personal Social Services in the appropriate management of doctors and dentists (practitioners), including those in general practice, whose performance gives cause for concern.” The Authority will provide a central point of contact for the HPSS where concerns about a practitioner’s performance arise. It will provide an advisory service to HPSS bodies, and take referrals from them so they can take appropriate and timely action in addressing concerns over poor performance. Under the agreement HPSS organisations now have access to the Authority’s services including: • immediate telephone advice, available on a 24 hour basis, regarding the handling of concerns about the performance of practitioners; • support to local case management including, for example, attending local case conferences; • assessment - where the concern about a practitioner is substantiated and significant but not so serious that patient safety is seriously at risk where referral to the GMC or GDC is required. The Authority is currently recruiting advisers, based in Northern Ireland who will be the focal point of the Authority’s service locally. Arrangements for Accessing the NCAA Initial contact with the NCAA about a specific case should be by telephone to the Direct Advice Line at 020 7084 3935. Other enquiries of a general nature should be to 020 7084 3850. Further details about the services provided are included in the NCAA handbook, which may be accessed through the NCAA website http://www.ncaa.nhs.uk.

Quality Awards
Rewarding excellence in healthcare The annual HPSS Quality Awards were
presented at the Institute of Healthcare Management Conference in the Slieve Donard Hotel on 25th November 2004. Chief Nursing Officer, Judith Hill presented the 3 finalists with Tyrone Crystal trophies and cash awards for the further development of their projects. The HPSS Quality Awards scheme is

run by the Department in partnership with the Institute of Healthcare Management.The scheme aims to recognise, reward and promote excellence in the provision of health and social care. “Once again the HPSS in Northern Ireland have demonstrated innovative and high quality services with 44 entries to the Awards” said Judith Hill. “The entries demonstrated a high standard of on-going quality improvement initiatives across many disciplines and services throughout the HPSS.” During a three-stage judging process, applications were assessed on how they met criteria such as quality of research, degree of innovation, clearly identified target groups, the use of consultation, evidence of need, multi-professional co-operation and effective use of resources. 1st Prize - Benign Prostatic Hyperplasia, Foyle Trust – the project addresses the inequalities in health care provision for men with

symptoms of Benign Prostatic Hyperplasia (BPH) living in the Foyle Trust area by developing the first nurse-led community based BPH clinic in Northern Ireland. 2nd prize - Elderly Rehabilitation, South East Belfast Trust – this project sets out to offer older people in hospital, who traditionally would be discharged to institutional care, the choice to be discharged home with a time-limited package of rehabilitation before they make a decision on future care needs and location. 3rd prize - Pre-hospital Thrombolysis, Sperrin Lakeland Trust – this project maintains Erne Hospital’s 24 hour pre-hospital coronary care threatened by the imminent implementation of the European Working Time Directives.The project provides a Nurse-Led Mobile Coronary Care Service which enables the skills and expertise of Coronary Care Nurses to be fully utilised in the interest of patients and has enabled this life saving and life enhancing service to continue.

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Service Improvement Conference

"Improve, Innovate, Inspire"
November 11th,Waterfront Hall, Belfast
On the 11th November 2004, the
Service Improvement Unit of the DHSSPS staged one of the largest and most successful single-day HPSS Conferences Northern Ireland has ever seen. The conference provided an opportunity for over 800 delegates to learn about the improvements and innovations that nearly seventy project teams have made from across the Primary, Secondary and Community Sectors of the HPSS. The Service Improvement Unit facilitates an innovative and systematic approach to service redesign in the HPSS and is currently in the 2nd year of the Service Improvement Programme. Project teams from the 1st wave of the Service Improvement Programme showcased their achievements alongside the improvement work undertaken by services outside of the Unit. “The energy and enthusiasm that the event created was truly tangible,” said Jillian Anderson, Service Improvement Unit. “During the day, delegates gained a real insight into how improvements were possible, gaining inspiration to look at their own services and implement the lessons learnt from their colleagues.”
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Speakers at the event included Patricia Gordon, Chief Executive of South & East Belfast HSS Trust, Clive Gowdy, Permanent Secretary of the DHSSPS, Jillian Anderson, Service Improvement Leader for the DHSSPS and Liz Carter, Director of the Modernisation Agency Associates. All the speakers congratulated the teams on their courage, commitment and determination to improve their services, encouraging delegates to embrace the tools and techniques of Service Improvement to transform their service into one that is good enough for them, their family and their friends. Delegates departed the Waterfront full of energy and enthusiasm as Miles Hilton-Barber, Blind Adventurer and International Motivational Speaker, and the Belfast Theatre Group, Playback brought the day to a rousing and inspirational close. For an application pack to submit a project for the 3rd wave of the Service Improvement

Programme or to learn more about the work of the Service Improvement Unit please e-mail the Unit at serviceimprovement@dhsspsni.gov.uk or go onto our extranet website at http://extranet.dhsspsni.gov.uk .

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Green Park Healthcare Trust – Baby Hip Clinic – Liz Algie, Winnie Moreland & Bernie Trainer United Hospitals – Celebration and Awareness of Diversity – Anne McCormill, Anita Hogg and Caroline Keown South and East Belfast HSST – Saving Soles (Podiatry) Linda McIlroy, Glenda Jess Morrison and Margaret McDonald Service Improvement Unit – Bronagh Mallon and Seamus Kavanagh The Conference

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Visitors from the East
Russian study visit to Northern Ireland
The Department
recently hosted a Russian delegation of senior social services managers, as part of a study visit focusing on the development of quality services in elderly care. The visit was one of the key activities in a 16-month project facilitated by Nicare, the overseas development agency of the Northern Ireland Health and Social Services, in partnership with the Russian Ministry of Health and Social Development. Under the EU ‘Institutions Building Partnership Programme’, the project is designed to promote the social rights of older people in the Russian Federation. “An estimated 30 million people in Russia are of pensionable age,” explains Jane East, “that is more than a fifth of the population, five million of whom require some kind of social services support. With the dramatic changes that have taken place in Russian society over the past 20 years, older people have seen their status, social networks and savings eroded, and many are living in extreme poverty.” The project brings together representatives of Social Protection Departments from administrative regions throughout the Russian Federation, stretching from the far Eastern border with Mongolia, to Siberia, and the Caucasus in the West. As part of the transition towards a managed market of social care, the setting of standards has been declared the highest priority for the Minister of Health and Social Development. The visit presented an opportunity for Russian colleagues to exchange ideas and information with the Department’s Standards & Guidelines Unit, and to discuss how they might initiate a similar process both at the regional and federal level in Russia. “The visit was a great success and our Russian colleagues reported that they gained valuable insights into policy issues, the standards development process and innovative social services provision for elderly people.” Jane East Project Support Manager, Nicare 12-22 Linenhall Street, Belfast BT2 8BS Tel: 028 9023 3788

Staff from the DHSSPS welcome Russian visitors to Castle Buildings

STARS IN THEIR EYES – WEST MEETS EAST
John Black, Project Officer, Standards Development Task Group

Along with three colleagues from the Eastern
Health & Social Services Board Registration & Inspection Unit, I recently had the good fortune to deliver a two-day workshop in Moscow on the development of standards and processes of regulation and inspection in social services. The aim of the workshop was to give Russian social care policy makers and practitioners an insight to the Northern Ireland approach to regulation, inspection and the development of standards. We looked at the role of registration and inspection within social services provision and addressed the development and use of standards in various social care

services. We also covered practical approaches to inspection using illustration from actual inspections in Northern Ireland. Our hosts were certainly eager to engage in debate, to learn from our experiences, and to challenge some of our assumptions. We also learned a lot about the delivery of social care in Russia, including some innovative, multi-disciplinary approaches to emergency situations. We visited local facilities to view best practice Russian style. Whilst physical conditions may not always have matched those back home, the commitment of staff to caring and meeting the needs of those using the services was abundantly evident. Each facility exuded a real "spirit" of care and consideration. Time for sightseeing was very limited, but our hosts did treat us to a visit to Star City just outside Moscow. This is where Cosmonauts are trained and we enjoyed the privilege of seeing inside a mock up of the space station. Overall, I was struck by the wonderful hospitality and friendliness of the Russian people and I will be keen to see how they develop their care standards and inspection processes over the coming years.
John Black gives presentation to Russian social care staff.

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Standards, Standards Everywhere!
Control As s u r ance S t a n d a rds

C A S

Standards will help providers of health and social care services improve
service delivery.With standards in various stages of development it would be useful to look at the purpose of these standards and the areas which they will cover. Controls Assurance Standards support effective governance in HPSS bodies. They are complementary to an organisation-wide system of risk management and by focusing on key areas of potential risk, they help HPSS bodies provide evidence that they are doing their reasonable best to manage themselves so as to meet their objectives and protect stakeholders against risk. Compliance with these standards will form part of the criteria for the new Quality in Health and Social Care Standards. Standards on Quality in Health and Social Care are being developed to underpin the Statutory Duty of Quality placed on HPSS organisations under the HPSS (Quality, Improvement and Regulation) (NI) Order 2003. These will be core generic standards, which will integrate existing standards on corporate governance with clinical and social care governance.They will apply to providers of primary, secondary and tertiary care within the HPSS. It is anticipated that these standards will be ready for public consultation shortly. Once agreed, they will act as a foundation for more detailed and specific criteria to be developed.The standards will cover the areas of governance, planning and delivery of services, well-being and safety, and communication and information management. Care Standards are being developed for services to be regulated under the 2003 Order. These standards are comprehensive and service-specific. They will cover a range of care services provided by public, voluntary and private organisations such as bursing homes, redidential homes, independent clinics etc. The care standards are being developed in 3 tranches and are at various stages in the consultation process. They will be backed by regulations and the first tranche will be published in final form for the 1st April 2005.

SS a n d a r d s o f t Q uta l i t y i n H e a l t h u &QS o c i a l C a r e &

Ca re Standa r d s

Ca

If you would like more information, please contact: Controls Assurance Standards Elaine Lawson Planning & Priorities Unit DHSSPSNI Room D1.1 Castle Buildings, Stormont Belfast BT4 3SQ 028 9052 3112 Elaine.lawson@dhsspsni.gov.uk Quality in Health and Social Care Suzanne Beaney Project secretariat DHSSPSNI Pharmacy and Prescribing Branch Room D3.22 Castle Buildings, Stormont Belfast BT4 3SQ 028 9052 0224 Suzanne.beaney@dhsspsni.gov.uk Care Standards Mary McStay Standards and Guidelines Unit DHSSPSNI Room D2.4 Castle Buildings, Stormont Belfast BT4 3SQ 028 9052 2207 mary.mcstay@dhsspsni.gov.uk

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✁ What do you think about the Quality Agenda?
Everyone in the Health and Personal Social Services will at some time be directly or indirectly affected by some new development in their work place or in their working practices related to the Quality Agenda. If you have any comments or concerns, positive or negative, about any element of the Quality Agenda we would like to hear your views. There are a number of ways you can contact us: 1. By email: quality.update@dhsspsni.gov.uk. 2. By telephone: 028 90 522028 3. By Fax: 028 90 523206 4. By cutting out this reply slip and returning to Standards & Guidelines Unit, D1 Castle Buildings, Stormont Estate, Belfast BT4 3SQ What do you think about the QUALITY AGENDA? This is your opportunity to let the Department know what you think about the Quality Agenda. Please use the space below to detail any issues of importance to you. Comment: Whilst recognising that the latest Shipman Inquiry Report may, in the future, amend revalidation, HPSS appraisal needs to continue, pending the outcome of this review. The Department will be seeking evidence from HPSS orginisations, in the near future, that doctors are participating in established HPSS appraisal schemes. HPSS orginisations should build on existing work to implement appraisal schemes and continue to improve the quality of appraisal schemes as an integral part of good governance.

GMC REVALIDATION SCHEME UNDER REVIEW - HPSS APPRIASAL TO CONTINUE The GMC’s proposed new system for revalidation
of doctors is under review in light of Dame Janet Smith’s recent recommendations - contained in the report “ Safeguarding Patients: Lessons from the Past - Proposals for the Future”. The Department of health in england, will lead this review which will also examine the role of NHS appraisal and the GMC’s arrangements for examining a doctor’s fitness to practice within the revalidation process. As a result, the intended launch of medical revalidation has been postponed from April 2005.

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Upcoming Quality Events
Please return to: Standards & Guidelines Unit D1 Castle Buildings Stormont Estate BELFAST BT4 3SQ Or Fax : 028 90 523206 Or email: quality.update@dhsspsni.gov.uk Please address any comments on this bulletin to : Standards & Guidelines Unit Room D1, Castle Buildings, Upper Newtownards Road, Belfast BT4 3SQ Or via email to quailty.update@dhsspsni.gov.uk or telephone 028 90 522028 This document can also be found on the DHSSPS website at www.dhsspsni.gov.uk Do you have an event happening within your Board, Trust or organisation that you would like to publicise through "Quality Update"? If yes, just let us know when and where the event is taking place and the nature of the event and we will include this in our new section on UPCOMING EVENTS. Just email quality.update@dhsspsni.gov.uk or telephone 028 90 522028 to provide details of your event.

UPCOMING EVENTS
Date 2nd February 2005 Time 12pm Where Stormont Hotel, Belfast Details Launch of CREST guidelines on Chronic Heart Failure

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