4 Nations Thematic Activity Conference CQC - 11 November 2011 RQIA Thematic Activity in Northern Ireland

Programmes of Thematic Activity Thematic Review Programme for Health and Social Care (HSC) Services Thematic approaches within the Programme of Inspections for Regulated Services Inspection Programme to fulfil RQIA responsibilities under the Mental Health Order HSC Infection Control and Hygiene Inspections Programme of IR(ME)R Inspections Joint inspections of Prison Health with Criminal Justice regulators

Review Programme

Review Programme

PEOPLE Gender Age Ethnicity Section 75 PLACE Geography Areas of Deprivation HSC Trusts Settings eg: Prisons, IHC Priorities for Action Themes Programmes of Care Programme Expenditure Service Frameworks PROGRAMME Legislation HPSS Quality Standards Human Rights A Healthier Future - Strategy for HSC in NI POLICY OVERALL HEALTH & SOCIAL CARE ASSESSMENT RQIA provides independent assurance about the quality, safety and availability of health and social care services in Northern Ireland, encourages continuous improvements in those services and safeguards the rights of service users Balancing the Review Programme

Proposed list of RQIA reviews for 2012 to 2015 Discharge arrangements from hospital Care of older people in acute hospital wards Care of patients with learning disabilities in acute hospitals Palliative care services Dementia care services Sexual Health Services Northern Ireland Respiratory Services Framework Services for stroke Management of controlled drugs in hospitals Nutrition in hospitals

Proposed list of RQIA reviews for 2012 to 2015 Access to services by disadvantaged groups Suicide prevention in the community Community services for acquired brain injury Community services for learning disability Diabetic retinopathy screening service Implementation of NI Single Assessment Tool for older people Implementation of NICE guidelines (1 per year) Governance arrangements in HSC organisations Review of systems which support professional regulation Overview of patient finances in residential settings Review of Northern Ireland Guardian Ad Litem Agency

Use of thematic approach in Mental Health and Learning Disability Services 1 April 2009: Assumed responsibilities under the Mental Health (NI) Order 1986

Core Activities Improving Care Informing the Population Safeguarding Rights Influencing Policy

RQIA’s approach Talking directly with service users their relatives and carers Patient Experience Reviews/ Inspection information and Intelligence Monitoring of detention and conditions of detention SAIs Early days – getting a baseline

Adoption of the Rights based approach –key principles of: Protection (2011/12) Respect Autonomy Fairness (2010/11) Equality

Framework for regulation Framework for regulation - Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 Subordinate regulations Associated service- specific standards

Thematic approach to regulation Selection of 4 standards or theme areas for each service on annual basis Focus on outcomes for users Themes selected by prioritisation Introduction of regulation for improvement

Identifying themes Issues identified by service users Concerns identified by regulation team Strategic/ political issues (currently: whistleblowing, complaints, care management) Unresolved major concerns

Selecting themes Categorisation of issues as weighted to quality or safety Application of prioritisation criteria Balancing tool approach Selection for all service types agreed with Director

Inspection template Possible alignment of themes with standards Criteria (indicators) identified from standards and other sources Correlation with regulations

Prioritisation factors - 1 Regional and/or national priority for safety and/or quality Variations in quality create a major risk for the population affected Area of significant or developing public concern

Prioritisation factors - 2 High proportion of the population is affected Evidence of a possible variation in quality arising from existing data and/or existing reports Recognised inequality in how health and social care services are provided

Proportionate approach “Dipstick” unannounced inspections Risk rating framework – Inspection Planning Tool Factors from regulations – focused on safety Individual regulation plans for each service