The Role of HIQA in Supporting Community Health Nursing Rachel Flynn, Director of Health Information and Standards HIQA

mission The Health Information and Quality Authority (HIQA) is an independent statutory authority established to promote safety and quality in the provision of health and social care services for the benefit of the health and welfare of the public. information requirements for a national patient summary for use in settings such as emergency and out-of-hours care and information requirements for community based electronic Prescribing. You have received both standard documents and the statement of assurance in advance of this meeting. We are seeking approval for those standards prior to submission to the Minister for health.  

How does hiqa support community health nursing? Sets national standards and guidance for health and social care services Undertakes national service-user experience surveys Defines the health information landscape information requirements for a national patient summary for use in settings such as emergency and out-of-hours care and information requirements for community based electronic Prescribing. You have received both standard documents and the statement of assurance in advance of this meeting. We are seeking approval for those standards prior to submission to the Minister for health.  

National Standards Person-centred Based on evidence and international best practice A key driver in quality and safety An impetus to recognise good practice and address poor performance information requirements for a national patient summary for use in settings such as emergency and out-of-hours care and information requirements for community based electronic Prescribing. You have received both standard documents and the statement of assurance in advance of this meeting. We are seeking approval for those standards prior to submission to the Minister for health.  

National Standards for the community

NATIONAL STANDARDS FOR ADULT SAEGUARDING HIQA and the Mental Health Commission jointly developed National standards for adult safeguarding to apply to all health, mental health and social care services recognising that people interact and move between a wide range of services While not all such services are within HIQA’s or the MHC’s regulatory remit the expectation is that all services will work to achieve these standards and promote and protect the rights of adults at risk of harm We have developed national standards for adult safeguarding to focus attention on the area of adult safeguarding. The aim of these standards is to reduce the risk of harm and promote the rights, health and wellbeing of all adults across the range of health and social care services that they engage with. The national standards outline a way of working for health and social care services and support the development of a culture where safeguarding is embedded into practice rather than being viewed as a separate activity. The standards support the development of integrated working in and between the range of health and social care services that people interact with, recognising that people may be at increased risk of harm when they are using multiple services or when they are moving from one service to another.

Putting standards Into Practice To raise awareness of what safeguarding is and to engage a wide range of stakeholders we developed a short animation. This animation has reached over 9000 people. We are developing further resources to support the implementation of the standards and to raise the awareness of both health and social care professionals and people using services of what safeguarding issues might look like in their service   https://www.youtube.com/watch?v=x51BzIV3vJY

GUIDANCE DEVELOPMENT Purpose to support service providers to understand the various national standards and to help them to practically implement them for the delivery of safe and effective health and social care services. Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

GUIDANCE ON A HUMAN RIGHTS-BASED APPROACH TO CARE AND SUPPORT IN HEALTH AND SOCIAL CARE SETTINGS Purpose Raise awareness of human rights and a human rights-based approach among staff delivering health and social care services. Support service providers and staff in understanding and implementing national standards Ensure effective delivery of care and support by putting the needs and rights of people using services at the heart of the service. Promote the use of a human rights-based approach to improve the quality of care, safety and quality of life of people using services This guidance is currently in development- due to be made available for public consultation in June 2019. We would like feedback from as many service providers and frontline staff as possible. -HIQA’s motivation in developing this guidance is: - to raise awareness of human rights and a human rights-based approach. This Guidance will support service providers and staff in their understanding and implementation of national standards . High-level reference is made to a human rights-based approach to care in a number of national standards developed by HIQA with emphasis placed on protecting and promoting people’s rights and respecting their autonomy, privacy, dignity, values, preferences and diversity:  National Standards for Safer Better Healthcare  National Standards for Residential Care Settings for Older People in Ireland  National Standards for Residential Services for Children and Adults with Disabilities  National Standards for Children’s Residential Centres  Draft National Standard for Adult Safeguarding. The Guidance will help to ensure a consistent interpretation of this kind of approach - The Guidance will also help to ensure the effective delivery of health and social care services which respects the individual’s human rights and puts the needs of people using services at the heart of the service. - By promoting this kind of approach and ensuring that people’s human rights are respected, protected and fulfilled, service providers will improve the quality of care, safety and quality of life of people who use health and social care services. The Guidance has primarily been written for staff working in health and social care services but might also be useful for people using services, their families, carers, friends and advocates.

National Care Experience Programme NATIONAL SERVICE-USER EXPERIENCE SURVEYS National Care Experience Programme HIQA HSE Department of Health Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

NATIONAL CARE EXPERIENCE PROGRAMME Established in 2019 To encourage people to share their experiences of care and to use this information to improve the quality and safety of these services The parent body for the National Patient Experience Survey and the forthcoming National Maternity Survey Two further surveys planned by 2021 Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

NATIONAL PATIENT EXPERIENCE SURVEY Ireland’s first acute inpatient experience survey carried out in 2017 and repeated in 2018 Move towards patient-centred care, policy and regulation Using patient feedback to improve quality and safety of care Third survey currently underway as of today – 1st May 2019

OVERVIEW NPES RESULTS 2018 Experiences of hospital care were mostly positive Patients experience high levels of dignity and respect in hospital The majority of patients also had confidence and trust in staff An important number of people highlighted issues of communication and information-sharing Emotional support from staff was not always available Some hospitals perform better than others Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

DISCHARGE STAGE OF CARE Lowest rated stage of care, 2017 & 2018 Many patients felt that they did not get enough information on how to safely care for themselves when they left hospital Patients who are not sufficiently informed about their condition are at higher risk of complications and being re- admitted After-effects felt in community health nursing Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

IMPROVING THE DISCHARGE PROCESS HIQA, through the NCEP, is supporting quality improvement initiatives All participating hospitals implemented improvements to their discharge processes e.g. introduced or revised patient information booklets on discharge Mercy UH, Cork UH Limerick Saolta HG

THE NATIONAL MATERNITY SURVEY Currently in development A national survey of women’s experiences of their maternity care Providing women who have recently given birth in Ireland with the opportunity to share their experiences of maternity services The aim is to learn from the experiences of these women to improve the safety and quality of the care they and their baby receive Scheduled for early 2020 Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

DEVELOPING THE NATIONAL MATERNITY SURVEY Systematic review Focus Groups Gap analysis Assembly of questions Delphi study Cognitive testing Survey pilot In collaboration with National University of Ireland, Galway (NUIG) Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

THE NATIONAL MATERNITY SURVEY QUESTIONNAIRE Prenatal care Antenatal care Care during labour and delivery Postnatal care in the community Capturing the whole pathway of care You and your baby Care while you were pregnant (antenatal care) Your labour and the birth of your baby Care in hospital after the birth (postnatal care) Feeding your baby Care at home after the birth Overall experience You and your household Themes: Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

NATIONAL MATERNITY SURVEY METHODOLOGY Model Design A retrospective survey design Eligibility Criteria Women who are 16 or over, resident in Ireland, during the survey period Exclusion Criteria Women who have had a stillbirth in the index pregnancy and women who have died or whose baby has died Mode of contact Post Mode of response Online primarily Paper option made available in second reminder letter and on request Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

When babies are 3 months old NATIONAL MATERNITY SURVEY TIMELINES Sampling Survey October 2019 MRH Mullingar Waterford UH Wexford GH Letterkenny UH Portiuncula UH St Luke’s GH Cavan GH Mayo UH MRH Portlaoise UH Kerry Sligo UH South Tipperary GH Home births NMH Coombe Rotunda CUMH Limerick UMH OLOL Drogheda Galway UH November 2019 February 2020 Women who gave birth in October 2019 March 2020 Women who gave birth in November 2019 When babies are 3 months old Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

COMMUNITY MATERNITY CARE The National Maternity Strategy, Irelands’ roadmap for a safer, better maternity service states: PHNs have a key role in supporting child health, families and new babies, screening for postnatal depression, providing breast feeding support and checking the baby’s development, amongst other services Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

NATIONAL STANDARDS FOR SAFER BETTER MATERNITY SERVICES Standards relevant to community health nursing: 4.1.26 Healthcare professionals in the community support women and their partners to make a confident and effective transition to parenthood and to develop parenting skills. 4.1.27 Women are advised of breastfeeding supports in the community and provided with materials containing contact information for these groups. 4.1.28 The lead healthcare professional for the postnatal period coordinates timely access to the following services for women and or their babies as required:….. Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

Contributing to a safer better maternity service in Ireland HOW CAN THE NMS BENEFIT COMMUNITY HEALTH NURSING? The National Maternity Survey will support community health nursing to meet its responsibilities as outlined in the National Maternity Strategy and the National Standards for Safer Better Maternity Services. It will do this by: Identifying which areas of post-natal community maternity care should be targeted for quality improvement Identifying which areas of post-natal community care maternity are working well Contributing to a safer better maternity service in Ireland Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

health information HIQA’s remit extends to providing leadership in defining the health information landscape in Ireland Driving improvements in the quality of health information Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

Person-centred view of health information Used to deliver and monitor safe and high quality care High quality and collected as close as possible to the point of care “collected once and used many times” Data collection should be ‘fit for purpose’ and cost effective Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

Sharing health information Improving the sharing of information between different healthcare settings Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

In Conclusion Thank you HIQA will continue to support community health nursing in its aim to improve the quality and safety of health and care services in Ireland Thank you Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet

Do you wish to participate in the Development of the national maternity Survey? We require participants to engage in a Delphi study The purpose is to select questions, by consensus, for inclusion in the National Maternity Survey The Delphi Study will be administered through an online tool Two rounds of questions Round 1: 16th – 31st May Round 2: 10th - 21st June Requirement to respond online during these periods We would be very grateful for your participation Should you wish to participate, please e-mail us at: info@patientexperience.ie Delphi study Handout For service providers: Supporting People’s Autonomy: Guidance - to support service providers to help those who use health and social services, in particular vulnerable people in their care, make informed decisions and live more independent lives. For the Service user: A5 guide booklet