Update: Patient Safety – Health 30th September, 2014

QUESTION NO:  463

 
  *  To ask the Minister for Health the ongoing steps taken to ensure patient safety; and if he will make a statement on the matter.

                                                                                         Bernard J. Durkan T.D.

 
REPLY.
Patient safety has become both a national and international imperative in recent years, with increased emphasis on patient safety in policy reform, legislative changes and development of standards of care driven by quality improvement initiatives.  The Commission on Patient Safety and Quality Assurance was established in Ireland in January 2007 and published its report in August 2008.  The Commission’s report provides the roadmap to developing a national culture of patient safety and recommends increased leadership and accountability throughout the service through new governance, management and reporting structures.  The Commission made a wide range of detailed recommendations in the following areas:
   
– Involvement of Patients, Carers and Service-Users in the system which covers communications, open disclosure etc.
– Leadership and Accountability in the system which includes governance, management and reporting structures,      education,training,research etc.
– Organisational and Professional Regulatory Framework which includes licensing of healthcare facilities, regulation of  healthcare professionals and credentialing;
– Quality Improvement and Learning Systems which includes evidence-based practice, clinical audit, adverse event  reporting, medication safety, health information and technology.

Since the publication of the Commission’s Report the Department and its Agencies have continued to work towards improving patient safety.

In addition, a number of HIQA Reports and investigations including the HIQA Investigation into UHG  (2013) and the CMO’s Report on Perinatal Deaths (2006-to date) in Portlaoise Regional Hospital earlier this year have informed policy on patient safety and demonstrate that we still face many challenges to ensure that our  health and social care services are truly safe and of the highest quality.

The HSE, in its National Service Plan 2014 has threaded through the Plan a requirement that at a time of further financial contraction, it is especially important to ensure that providing the best level of care for patients and service users, must be at the forefront of planning for and management of services. This commitment is also a central theme of Future Health – A Strategic Framework for Reform of the Health Service 2012-2015 . To this end, the HSE has emphasised specific measures focused on quality and patient safety in the Service Plan including HCAIs, Medication Safety and implementation of Early Warning Score Systems.  My officials meet with the HSE each month on the Service Plan and patient safety is a standing item on that agenda.

There are many facets to the patient safety agenda and several initiatives underway have the potential to drive significant change throughout  health service provision over the coming years.  The leadership of this change from a governance and management perspective will be a key dimension of progressing towards this goal.

I will just detail briefly below some of the key initiatives introduced to progress patient safety:

• The establishment of the Health Information and Quality Authority (HIQA) which is the independent authority responsible for driving quality, safety and accountability in residential services for children, older people and people with disabilities in Ireland.  HIQA also sets, monitors and inspects against healthcare standards.
• Approval and publication of HIQA’s National Standards for Safer Better Healthcare  in June 2012.  
• Clinical effectiveness is a key component of safe, quality care.  To this end the Minister for Health established the National  Clinical Effectiveness Committee (NCEC) in 2010 to provide a framework for national endorsement of clinical guidelines and audit to optimise patient care.   To date, three National Clinical Guidelines have been  launched: the National  E arly Warning Score for Ireland (NEWS), the Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA) and Surveillance, Diagnosis and Management of Clostridium difficile Infection in Ireland.     Each guideline has been subject to an economic evaluation and implementation will be monitored through the HSE’s monthly Performance Assurance Reports, compliance with HIQA’s National Standards for Safer Better Healthcare and increased alignment with the clinical indemnity scheme.
• An additional four guidelines were commissioned by my predecessor, arising out of the HIQA report into the Halappanavar case: Sepsis, Paediatric Early Warning Score (PEWS), Maternal Early Warning Score (MEWS) and Clinical Handover.   It is planned to launch the Sepsis and MEWS Guidelines in November.
• A National Patient Safety Advisory Group has been established to support my Department in providing national leadership on patient safety and quality and to advise on the development of policy in the area of patient safety and quality.
• Legislative proposals are at an advanced stage of development by my Department for the itroduction of a national licensing system.  This will provide for a mandatory system of licensing for public and private health service providers.
• Much of the legislation governing healthcare professionals has been extensively updated and amended in recent years with the publication of a number of relevant Acts including the Medical Practitioners Act 2007 and the Nurses and Midwives Act 2011.
• ‘Patient Safety First’  is an awareness raising initiative through which healthcare organisations declare their ongoing commitment to patient safety.   The overall branding was supported by a new Patient Safety First logo and the launch of anew website ( www.patientsafetyfirst.ie .)
• The  establishment by the HSE of the Directorate of Quality and Patient Safety in order to strengthen the HSE’s internal quality and risk framework.  
• Establishment of HSE’s National  Incident Management Team.
• The establishment by the HSE of its  Advocacy Unit, the publication of the HSE’s Patient Charter ‘ You and Your Health Service ‘ and the launch of the WHO’s Patient Safety Champion’s Network .  
•   A National Policy on Open Disclosure was developed jointly by the HSE and the State Claims Agency and launched in November 2013.  Implementation of the policy across all health and social services has now commenced by the HSE.
• The Royal College of Physicians in Ireland and the HSE have jointly set up the Clinical Programmes  to provide strategic leadership to develop and roll out models of best practice in clinical care nationally.
• The upgrading by the Clinical Indemnity Scheme of the national confidential web-based clinical incident reporting system, STARSweb to the National Adverse Event Management System (NAEMS).  

Many of these patient safety initiatives have made significant progress in terms of legislative, regulatory and structural changes.  Changing culture and developing processes for patient safety are critical to delivery of a quality safe healthcare service.  A quality and safety culture ensures that quality and safety is seen as fundamental to every person working within that service, including clinical and non-clinical staff, healthcare managers and the Board, or equivalent, of an organisation.