On behalf of HIQA, I thank the Chairman and members for the opportunity to address the Committee of Public Accounts this morning. I am accompanied by my colleagues, Ms Mary Dunnion, director of regulation and chief inspector of social services, and Sean Angland, acting chief operating officer. In the interest of being efficient with time and facilitating questions from members, I will address the key in my opening statement that has already been circulated to the committee.
HIQA is the independent body established ten years ago to improve health and social care services for the people of Ireland. Our role is to develop standards, inspect and review health and social care services, and support informed decisions on how services are delivered. Our mandate extends across a range of public, private and voluntary service sectors.
The Health Act 2007, which established HIQA, outlines our statutory functions and provides the basis for our work. Our remit has grown substantially over the past decade but our core activities remain the same. They are to monitor and regulate health and social care services; develop standards; carry out health technology assessments; and advise on the collection and sharing of information across health care services.
All these functions are focused on making services safer and better. We provide assurance to the public as to the quality of services and endeavour to ensure that the findings of our work are reflected in decision-making at local and national level. HIQA's primary aim is to safeguard vulnerable people. Putting the needs and the voices of the people who use services to the fore is the essence of everything that we do.
HIQA plans and manages its resources prudently to make certain that they are used efficiently and effectively as we carry out our statutory functions and deliver our corporate objectives. We are conscious of providing value for money and ensure that we are compliant with all relevant standards, regulations and legislation concerning our use of resources. HIQA derives its revenue from a mixture of public and private sources. In 2016, we were granted an allocation of just over €11.5 million from the Department of Health and also received just under €7 million in annual fees and registration fees from centres that are registered. We also earned €467,000 in other income such as pension contributions and grants. In 2016, we came in under budget and returned €519,000 to the Department of Health, primarily due to delays in the sanctioning of vacant and new posts.
Over two thirds of HIQA's expenditure goes on staff costs, which amounted to just over €14 million last year. Our headcount in December 2016 was 192 permanent staff and that now stands at 209 staff. Subject to sanction from the Department of Health, we plan that this figure will grow to 227 based on current funding. In addition, a number of staff are employed through agencies and on fixed-term contracts. The majority of permanent staff, and that is 144 of our staff, work within the regulation directorate.
In our code of governance and code of business conduct, we have set out key roles and responsibilities within HIQA and the procedures and protocols that are core to our good governance. As well as policies and procedures for governing the business of the board, we also set out guidelines for ensuring that the authority conducts its business ethically. The code describes the obligations on staff, board members and individuals contracted by the authority in the performance of their duties, and includes requirements for making declarations of interest as set out in Ethics in Public Office Acts.
In recent years we have significantly strengthened internal controls and governance arrangements through an annual statement of assurance to the board. We have also reviewed our compliance with the new code of practice for the governance of State bodies as part of our internal audit programme. HIQA is currently being assessed for compliance with the National Standards Authority of Ireland’s SWiFT 3000 code of practice for corporate governance assessment. The process is near completion and we expect to be awarded certification shortly. In HIQA, we recognise the importance of external and independent oversight and we are open to and welcome such oversight.
The Comptroller and Auditor General in his audit of our financial statements in 2016 provided a clean audit report. The C&AG referenced two items: accounting for the costs of superannuation payments and the exit of a lease. In accounting for superannuation payment, as directed by the Minister for Health, we account for pension costs as they arise rather than accruing for them. The exit of a lease relates to a lease that was transferred to HIQA from the Irish Health Services Accreditation Board, a predecessor organisation, upon HIQA’s establishment. We are happy to answer any questions the committee has on these matters.
Since the recruitment moratorium was imposed in 2009, as many other bodies, HIQA has had to seek specific approval for the filling of every post it wants to fill. The situation in which every vacancy that arises and every new post sought requires external sanction creates significant operational challenges for an independent body such as HIQA. While there has been an improvement in this process, delays in filling posts impact on our operational capacity, particularly in the area of the regulation of services. It also has the potential to create additional operational costs where temporary staff are required to complete our work. We are very conscious of the importance of strategic resource planning and have recently submitted to the Department a strategic workforce plan that details how current risks within the regulated environment and future functions should be addressed.
HIQA’s organisational structure reflects our core functions and activities. HIQA’s regulation directorate is the biggest in the authority and is responsible for promoting improvement in specified health and social care services in Ireland by regulating the quality and safety of the services. HIQA has statutory responsibility for registering and inspecting designated social care services. So far this year, we have carried out 650 inspections of designated centres for people with disabilities and over 450 inspections of designated centres for older people. Of the inspections of centres for older people, 90 were themed inspections focused on the care given to people with dementia. The number of designated centres is continually increasing and diversifying, which in turn affects our workload.
HIQA has statutory responsibility for monitoring and inspecting children’s social services, including children’s statutory residential centres, special care units, child protection services and Oberstown child detention campus. We also have a statutory responsibility for monitoring foster care services against the national standards for foster care. So far this year we have conducted a total of 38 inspections of children’s services. We are also responsible for monitoring the safety and quality of health services and investigating, as necessary, serious concerns about the health and welfare of people who use these services. As a result of the limitations in numbers of our health care team to date, our health care programmes have been thematic, focused on inspecting nutrition and hydration care in our acute hospital sector, reviewing how public acute hospitals are tackling antimicrobial stewardship and medicines management and monitoring acute hospitals’ compliance with the relevant national standards. The total number of inspections carried out by HIQA across all of these sectors has increased from 920 in 2013 to 1,477 in 2016. This represents an increase of over 60% in the number of inspections carried out in those three years. Since our establishment we have also conducted eight statutory investigations, and we have recently commenced a new investigation into Tusla’s management of allegations of child sexual abuse against adults of concern, as requested by the Minister for Children and Youth Affairs.
We are responsible for developing a consistent and standardised approach to health information, based on standards and international best practice. Health and social care services are information dependent, generating huge volumes of data every day. It is important that such information is managed in the most effective way possible in order to ensure high quality, safe health and social care delivery. We also work with stakeholders to develop national standards for health and social care services and for people living in residential services. Such standards include standards for children's residential centres and the draft national standards for the prevention and control of health care associated infections in primary and community care and also in acute hospital services.
The national patient experience survey is a joint initiative led by HIQA with the HSE and the Department of Health. It is the largest single survey of the health care system ever conducted in Ireland. The first survey was conducted in May 2017 and will now run annually. Almost 14,000 hospital patients responded to the 61-question survey which translates to a response rate of 51%. We plan to publish the national report this December along with 39 acute hospital reports.
HIQA is also responsible for providing advice that enables the best outcome for people who use our health service and the best use of resources by evaluating the clinical effectiveness and cost-effectiveness of drugs, equipment, diagnostic technologies and health promotion and protection activities. Health Technology Assessments, HTAs, are undertaken at the request of the Minister and his Department or at the request of the HSE to inform major health policy or health service decisions. We are currently undertaking a HTA on extending the national immunisation schedule to include providing the HPV vaccine to boys. Another example of a HTA published earlier this year was an assessment of smoking cessation interventions.
HIQA is a highly efficient and productive organisation that carries out a broad and ever growing range of activities. We are working with the Government to ensure our resources and processes meet the range of new areas of responsibility to be included under HIQA’s growing remit. Areas where it is planned that HIQA’s role will grow in the foreseeable future include the regulation of patient exposure to medical ionising radiation; the formal regulation of children’s residential centres, which will include voluntary and private sector services; and the expansion of the national patient experience survey to include areas such as maternity services. Furthermore, we will continue to participate and contribute to the preparatory work in developing a licensing model for public and private health care facilities, expanded functions under the health information and patient safety Bill and expansion into new areas of social care regulation such as home care services.
Today I have provided a brief overview of HIQA’s current and future work. As an organisation, over the past ten years we have contributed positively and constructively to public confidence in Ireland’s systems of health and social care regulation, standard setting and evidence based strategic advice. At all times we have endeavoured to be an exemplar organisation in our internal governance systems and have endeavoured through our performance to provide value for money, efficiency and accountability. I thank the committee for inviting us here this morning and am very happy to answer any questions it has.
