Why does the system need reforming?
The Department of Health, Social Services and Public Safety (DHSSPS) is concerned that there are "unacceptable variations in the quality of care and treatment". It believes efforts to improve services are hindered by guidelines and standards emanating from a variety of sources.
The Department of Health has already introduced national measures to clear up this confusion in England and Wales. These include the National Institute for Clinical Excellence (Nice), which ensures the best treatments are made widely available, and the Commission for Health Improvement (Chi), which reviews the quality of healthcare provided by the NHS through an inspection programme.
What reforms are proposed?
A consultation document, Best Practice - Best Care, published last week, sets out a framework for setting standards, strengthening accountability for the services delivered, and improving monitoring and regulation.
How would standards be improved?
First, the department proposes to introduce service development frameworks. These would cover the whole system of care for a particular service (for example, mental health) and provide a holistic approach to planning, delivery and monitoring of services. The frameworks would spell out where care is best provided, e.g. primary care, hospital or a specialist service; set the standard of care that patients should receive, and establish performance measures that would be used to check the quality of service provided.
Second, a single source for the production and dissemination of guidelines and standards would be set up. In England, this "source" is Nice. Its remit is to remove clinically ineffective, non-cost effective, or unsafe treatments from the NHS, while making sure the best treatments are made widely available and fairly to patients, thus ending the postcode lottery where access to treatment varies between health authorities. A similar body for social services, the Social Care Institute for Excellence (Scie), will be established later this year.
Most guidelines from Nice or Scie are expected to be applicable to Northern Ireland, so the DHSSPS would prefer to use them rather than create its own specific similar organisations. A standards board would be set up to decide which standards were applicable, and produce or commission specific guidelines where appropriate.
How would the delivery of services be improved?
A system of clinical and social governance, underpinned by a statutory duty of quality, would ensure health and social care organisations are accountable for continuously improving standards.
Clinical and social care governance would rectify poor practice through education, training and research, risk and complaints management, evidence-based practice and continuing professional development.
The duty of quality would place a statutory requirement on health and social services boards, health and social services trusts and special agencies, such as the Northern Ireland Blood Transfusion Service, to put and keep in place arrangements to improve and monitor the quality of care they provide to individuals.
How would monitoring and regulation be improved?
A health services improvement authority would be established to independently monitor social services in a similar way to which Chi assesses standards of healthcare in England and Wales. Chi plans to inspect every NHS trust, health authority through a programme of clinical governance reviews. These reviews inspect each body for quality of patient care; whether clinical staff are up to date in their professional practice, and whether safeguards are in place to prevent clinical errors.
The Northern Ireland Commission for Care Services would take over the work presently carried out by the registration and inspection units within the four health and social services boards. It would register and inspect a wider range of care services including the private and voluntary sector; investigate complaints; where necessary enforce action to ensure standards are improved; serve improvement notices; prosecute and where necessary de-register services; monitor employment practices, and work with other bodies including the health and social services improvement authority.
When will these reforms take place?
The document is out for consultation until July 18. However, the DHSSPS has produced several policy documents that have made little progress through the Northern Ireland assembly. Department of Health sources claim the proposals stand little chance of coming into effect because of the ongoing political deadlock in the province. It is also thought that Sinn Fein members would prefer to have closer ties with the Republic of Ireland's health service.
