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Information about THE SUPERVISORY ORGANISATION(s) in

1. COUNTRY/REGION:. Northern Ireland
The Regulation and Quality Improvement Authority (RQIA)
Website of the supervisory organisation: www.rqia.org.uk

Is this website in English or partly in English? English

General Contact person:    Mr Malachy Finnegan
Name and function     Malachy Finnegan, Communications Manager
Address RQIA, 9th Floor, Riverside Tower, 5 Lanyon Place, BELFAST, BT1 3BT
Email:     malachy.finnegan@rqia.org.uk
              info@rqia.org.uk
Telephone number    +44 (0)28 9051 7485
Mobile phone

Contact person(s):     Mr Glenn Houston
Name and function     Glenn Houston, Chief Executive
Address RQIA, 9th Floor, Riverside Tower, 5 Lanyon Place, BELFAST, BT1 3BT
Email:      glenn.houston@rqia.org.uk
Telephone number    +44 (28) 9051 7400
Mobile phone

Contact person(s):     Mrs Kathy Fodey
Name and function     Kathy Fodey, Director of Regulation and Nursing
Address RQIA, 9th Floor, Riverside Tower, 5 Lanyon Place, BELFAST, BT1 3BT
Email:      kathy.fodey @rqia.org.uk
Telephone number    +44 (0)28 9051 7440
Mobile phone

Contact person(s):     Dr David Stewart
Name and function     David Stewart, Director of Reviews and Medical Director
Address RQIA, 9th Floor, Riverside Tower, 5 Lanyon Place, BELFAST, BT1 3BT
Email:      david.stewart@rqia.org.uk
Telephone number    +44 (0)28 9051 7492
Mobile phone

Contact person(s):     Ms Theresa Nixon
Name and function Theresa Nixon, Director of Mental Health, Learning Disability and Social Work
Address RQIA, 9th Floor, Riverside Tower, 5 Lanyon Place, BELFAST, BT1 3BT
Email:      theresa.nixon@rqia.org.uk
Telephone number    +44 (0)28 9051 7564
Mobile phone

2. THE STRUCTURE OF THE SUPERVISORY ORGANISATION(s)
The Head of the Supervisory Organisation (name and function).
Mr Glenn Houston, Chief Executive

Size of the Supervisory Organisation:
Number of inspections/supervisions or number of inspectors or number of full time equivalents of people working in the organisation; number of hospitals or health institutions under supervision
RQIA conducts in excess of 3,000 inspections of regulated health and social care agencies and establishments annually, and further range of reviews in statutory health and social care organisations annually.
RQIA also conducts a range of announced and unannounced infection prevention/hygiene inspections in health and social care facilities.
Under the Mental Health (Northern Ireland) (Order) 1986, and its duties as a National Preventive Mechanism (NPM) under the UN Optional Protocol to the Convention Against Torture, RQIA conducts a range of inspections and reviews of mental health and learning disability services. These include direct contact with patients and service users who are subject to detention and guardianship under the Mental Health Order.
All RQIA inspection and review reports are available at: www.rqia.org.uk

Number of people working in the organisations: 140

Other relevant information about the Supervisory Organisation in your country or region
RQIA registers and inspects a wide range of health and social care services. Our inspections are based on service-specific regulations and minimum care standards, which ensure that both the public and service providers know what quality of services is expected.
Our inspectors visit a range of services including nursing, residential care and children's homes to examine all aspects of the care provided, to assure the safety and dignity of those using the facilities, and ensure public confidence in these services. We are also responsible for the regulation day care settings, domiciliary care agencies, nursing agencies and a range of independent health care services, including private dental practices.
RQIA also has a role in assuring the quality of services provided by Health and Social Care (HSC) Board, HSC trusts and agencies, to ensure that every aspect of care reaches the standards laid down by the Department of Health, Social Services and Public Safety (DHSSPS) and expected by the public.
Under the Health and Social Care (Reform) Act (NI) 2009, RQIA undertakes a range of responsibilities for people with a mental ill health and those with a learning disability. These include: preventing ill treatment; remedying any deficiency in care or treatment; terminating improper detention in a hospital or guardianship; and preventing or redressing loss or damage to a patient's property.
Web address www.rqia.org.uk

3. THE SCOPE OF THE SUPERVISORY ORGANISATION(s)
Is there supervision on health care in general?
RQIA regulates and reviews the availability and quality of health and social care across all sectors in Northern Ireland - (regulated sector services and statutory health and social care provision). These include:
• Adult placement agencies
• Boarding schools
• Children’s homes
• Day care settings
• Domiciliary care agencies
• Family practitioner services
• Fostering agencies
• Independent clinics
• Independent hospitals
• Independent medical agencies
• Nursing agencies
• Nursing homes
• Private dental practices
• Residential care homes
• Residential family centres
• Voluntary adoption agencies
• Health and Social Care Board
• Health and social care trusts
RQIA reports to the DHSSPS on all matters relating to the above, including serious service failures and significant failings.
RQIA also has a range of functions under the Mental Health (NI) Order 1986 as amended by the Health and Social Care (Reform) Act (Northern Ireland) 2009. RQIA also has responsibilities under the Ionising Radiation (Medical Exposure Regulations (Northern Ireland) 2000 (IR(ME)R).

Is there supervision on hospitals?
RQIA has regulatory oversight of both statutory and independent hospitals. RQIA also carries out a programme of infection prevention/hygiene inspections at hospital wards and clinical areas.

Is there supervision on other health care institutions like nursing homes / convalescent homes?
RQIA has regulatory responsibility for: children’s homes; day care settings; independent clinics; independent hospitals; nursing homes; residential care homes; domiciliary care agencies; fostering agencies; independent medical agencies; nursing agencies; voluntary adoption agencies; residential family centres; adult placement agencies; and boarding schools.

Is there supervision on the production and the use of medicines?
There is regulation on the production of medicines, however, this is not the responsibility of RQIA..
There is responsibility under regulations for assessments to be made of the systems for medicines management in regulated sector services.

Is there a supervisory relation with health care professionals? If yes, what kind of relation?
RQIA does not have direct supervisory or regulatory responsibility for health and social care professionals. However, it has a range of formal and informal agreements with professional regulatory bodies such as the General Medical Council (GMC); Nursing and Midwifery Council (NMC); and the Northern Ireland Social Care Council (NISCC).

Other relevant information about the scope of the supervisory organisation.
RQIA is a non-departmental public body, sponsored by Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland
RQIA is a designated National Preventive Mechanism (NPM) under the UN Optional Protocol to the Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT).
RQIA is also a designated body under the provision of the Public Interest Disclosure (Northern Ireland) Order 1998 to which individuals may make a whistleblowing disclosure.

4. METHODS OF INSPECTATION OR SUPERVISION
What methods of inspection or supervision are used in your country/region?
RQIA use a range of inspection and review methodologies, based on the principles of the Better Regulation Commission.
RQIA’s inspections of regulated services are conducted by a range of qualified and experienced staff including nurses, social workers, pharmacists, estates and finance officers. Inspections may be announced or unannounced, and examine compliance with regulations and the minimum standards in the areas of care, medicines management, estates and finances.
The Regulation and Improvement Authority (Fees and Frequency of Inspections) Regulations (Northern Ireland) 2005 and associated amendments determine the minimum number of inspections for each category of service. Each year RQIA is required to inspect all children’s, nursing and residential care homes on a minimum of two occasions, with all other regulated services subject to at least one inspection per year.
RQIA's approach to regulation reflects its Corporate Strategy 2012 - 2015 which sets out our mission:
"RQIA provides independent assurance about the safety, quality and availability of health and social care services in Northern Ireland, encourages continuous improvements in these services and safeguards the rights of service users”.
RQIA’s four core activities support our vision of being a driving force for positive change in health and personal social services in Northern Ireland:
• Improving Care
• Informing the Population
• Safeguarding Rights
• Influencing Policy
Consistent with our strategic approach, a number of principles characteristic of good regulatory practice have been identified (Better Regulation Task Force (2003), Principles of Good Regulation).
These lead to the following practice recommendations:
1 Focus on Outcomes
Inspection should consider “service delivery to the end users of the services rather than concentrating on internal management arrangements”.
The criteria in each minimum standard focuses on the processes necessary to achieve good outcomes. It is important that inspection staff take steps to identify outcome-based evidence to validate compliance with the standards. The possibility of overlooking outcomes when considering statements, such as those within the criteria, has been clearly described:
“The risk is that attention becomes focused primarily on minimum standards, inputs and processes, rather than regulation promoting improved outcomes and encouraging the sector to strive for improved standards.” (Duncan (2007) Journal of Care Services Management, vol. 2, no.1, pp. 17-27, Inspecting for Improvement.)

2 User Perspective
Inspection should “focus on the experience of those for whom the service is provided, as well as on internal management arrangements”.
This recommendation builds on the focus on outcomes, making it clear that inspectors should place significant emphasis on the directly reported experience of service users. This experience can validate the authenticity of apparent operational arrangements and, where it can be accessed, should be cited in reports as strong evidence of the degree of compliance with standards. This will mean that inspectors will seek to identify how compliance with a particular criterion should affect service delivery and will then seek verification from users. Comments made by users about relevant parts of service delivery should then be quoted or summarised within the report.
3 Self-assessment
Registered establishments and agencies are responsible for the quality of care provided and are required to complete a self-assessment for RQIA demonstrating how they are meeting both the standard and criteria.
In all instances, inspectors should seek to find evidence that either confirms, or refutes, the provider's self-assessment. Such evidence should be specified in reports.
4 Evidence
Reports should specify the evidence that has been taken into consideration in reaching judgements.
Evidence to underpin the inspector's judgement should be identified during the inspection, and should be cited in the report. The “evidence, whether quantitative or qualitative, should be validated and credible”.
The credibility of evidence can be established primarily by validation - the process of triangulation or corroborating evidence by information from a different source. Credible and validated evidence that a policy on training, for example, is in place could be sought from:
• training records and curriculum
• discussion with staff that indicates that they are appropriately knowledgeable or skilful and discussion with service users that indicates the relevant task is being carried out competently.
5 Follow-Up Evidence from Previous Requirements and Recommendations
An inspection will commence with the inspector requesting evidence that requirements and/or recommendations from a previous inspection have been met to the inspector's satisfaction. Thus, it is important for the provider to ensure they are prepared and are able to evidence how these requirements/recommendations have been met in full.
6 Core Criteria
Each year RQIA identifies specific standards for each service type and, where appropriate, a number of core criteria in order to assist the process of the inspection and to ensure sufficient time is available to gather and validate the experience of service users. This approach ensures that inspectors take time to review the overall operation of individual services, alongside detailed assessments against identified criteria.
Infection prevention/hygiene inspections of statutory health and social care facilities are unannounced, using specialist inspectors employed by RQIA and a range of external peer reviewers with specialist knowledge in hygiene and infection prevention/hygiene. In addition, one annual announced inspection is made to each health and social care trust to examine governance arrangements for infection prevention/hygiene.
Governance, service, thematic reviews and investigations utilise a range of methods. In the main, reviews are conducted by expert peer reviewers with specific knowledge in the area being reviewed, and also involve lay reviewers.
The methodological approaches include: self-assessment; validation visits; inspection; audit; root cause analysis; staff surveys; user/carer surveys; and care pathway mapping.
Under the functions of the Mental Health (NI) Order 1986 the methods of assessment, review and inspection are similar to those outlined above, with the addition of patient experience reviews. These reviews afford people detained under the Mental Health (Northern Ireland) Order 1986, an opportunity to speak to RQIA inspection staff to describe their experience of detention and care.

Other information about the methods of inspection in your country / region
Other regulators commission other organisations to monitor against standards

5. WHAT IS THE COMPETENCE OF THE SUPERVISORY ORGANISATION IN YOUR COUNTRY?
Is the supervisory organisation entitled to use compulsory measures (sanction/repression/enforcement)
Under The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003, RQIA has powers of entry and inspection of a range of health and social care organisations, establishments and agencies. The various sanctions available to RQIA are set out in the Health and Personal Social services (Quality, Improvement and Regulation) (Northern Ireland ) Order 2003 and in RQIA’s Enforcement Policy and Procedures. These powers are further extended to the RQIA under the Mental Health (NI) Order 1986 as amended by the Health and Social Care (Reform) Act (Northern Ireland) 2009.
All services that require to be registered must make application for registration with RQIA. In achieving registration, these services must meet the minimum standards and regulations for registration.

Is the supervisory organisation entitled to take precautions and implement measures to prevent accidents or incidents?
All regulated care providers are required to report specific accidents and incidents to RQIA, which can lead to follow-up action to address any issues identified.

Does the supervisory organisation have the authority to close institutions or stop non proper healthcare
RQIA has in its remit a range of enforcement actions in respect of regulated sector services. These actions include: making recommendations; legal, time bound requirements; improvement notices; notices of failure to comply with regulations; imposing conditions of registration; fines; and closure of agencies or establishments.
In relation to statutory health and social care services, RQIA may make recommendation for special measures to be considered by the Minister for Health, Social Services and Public Safety.

Is the supervisory organisation allowed to interfere in other ways? Can remove licence, enforce recommendations for social care centres. If yes, in what way?
RQIA can, in certain circumstances, cancel the registration of a registered person and/or the registered manager. In such circumstances RQIA would also refer the persons concerned to the relevant professional regulatory authority.

Other relevant information about the competence of the supervisory organisation

6. INTERESTING ONGOING DEVELOPMENTS IN YOUR COUNTRY/REGION
RQIA’s current Corporate Strategy for 2012-15 and also its three-year review programme for the same period were developed following extensive consultation with stakeholders and the public. These documents outline RQIA’s key priorities for the period in all aspects of its work.

You can access further information about the work of RQIA at www.rqia.org.uk.

General Contact: Malachy Finnegan, Communications Manager,
Email: malachy.finnegan@rqia.org.uk or info@rqia.org.uk
Tel: +44 (28) 9051 7485