'Denying the disabled fresh air is abuse,' warns safety chief
Hiqa staff are viewed as snoops but they are key to safety, writes Eilish O'Regan
Prisoners have more access to fresh air than some vulnerable residents of homes for the intellectually disabled, the head of the country's patient watchdog has revealed.
Until recently, these residents may also have endured months of being confined within the four walls of their home in a congregated setting, bleakly facing the same institutionalised daily routine, according to Phelim Quinn, chief executive of the Health Information and Quality Authority (Hiqa).
"In some instances, staff did not see that as an abuse of someone's rights. But it is," he said.
"If you were in prison, you would have a right to fresh air and being allowed out, so why would you not be allowed them in a state-funded centre?"
It was only three years ago that Hiqa inspectors were first permitted past the threshold of these disability centres.
The worrying failure to put them under outside scrutiny for so long meant that many entrenched practices were left unchecked.
Mr Quinn said Hiqa has now visited all the centres but it is still having to commit significant time and resources to risk-based inspections, where residents' safety has been breached. It had to take enforcement action against four centres last year.
The abusive practices at one of the bungalows in Áras Attracta home in Mayo, which was the subject of a television expose, were not isolated.
"The person in charge is the critical lynchpin. We found that where there is a strong manager, care can be good in congregated settings," he said.
Mr Quinn took over the running of the watchdog two years ago after decades of work in health and social services. Hiqa has a small army of 77 inspectors, whose work also covers hospitals and nursing homes, as well as child welfare and protection services.
Many in the health service still regard them as intrusive snoops, particularly when the inspection is unannounced, but the sometimes shocking findings of Hiqa reports have been crucial in disclosing risks to patient safety.
Mr Quinn said that in the area of hospital hygiene checks, they are moving from wards to high-risk areas, like intensive care units.
It has meant that they are seeing failings that are forcing them to make return visits to do follow-up checks.
"Our re-inspection rate in hospitals was one in 10 visits, now it is one in five," he said.
Enda Kenny's local hospital, Mayo General, recently received a scathing report with patients left at risk of infection.
Mr Quinn said the various hospital inspections have highlighted a range of risk, such as patient equipment not being properly decontaminated.
Smaller hospitals continue to have a problem with the misuse of antibiotics, which can lead to more superbugs.
However, he said the evidence is that more staff are washing their hands between patients.
"Hospitals are now well aware that if we are not happy with standards we will be back again," he said.
It has recently started inspecting hospital meals, which have received surprisingly good reviews from patients to date.
However, more patients need to be screened for malnourishment.
"Food nutrition and hydration are an important part of care. But it is sometimes seen as a hotel service," Mr Quinn said.
Last year, Hiqa did battle with the HSE over the watchdog's report on Portlaoise Hospital, which looked at standards following the deaths of a number of babies in its maternity unit in recent years. The HSE threatened to injunct the reports but Hiqa stood its ground.
The Irish Independent later reported how HSE chief Tony O'Brien texted Mr Quinn seeking an "informal off-line chat" about the report. But Mr Quinn did not respond.
Following on from these and other Hiqa reports all maternity hospitals and units must now give monthly statistics on patient deaths, the number of reported critical incidents and other information. When Hiqa started its investigations it found some were not even producing annual reports, so the public had no idea how good or bad the standards were.
"When we published the Portlaoise report we said the health system was not learning. We have now submitted new national maternity standards to the Minister for Health."
One area of ongoing concern to Hiqa, for which it has no powers of inspection, is home care services for the elderly and disabled. It is among the areas for regulation prioritised by Hiqa in its submission to the Oireachtas committee which is drawing up a ten year plan for the health service.
Mr Quinn said Hiqa inspectors will also continue to pursue better quality of life standards for the elderly in the old-style public nursing homes with nightingale wards, which are to be phased out by 2021.
He said: "I appreciate staff sometimes feel hurt. But older people are living there now. They need personalised space for their own effects, privacy and dignity. Practices have derived to suit the environment, as opposed to the individual."
What about the failure to hold anyone to account when the dust has settled on some of its controversial reports? Hiqa has no role in this but is proposing an independent commission, removed from the HSE and hospital groups which would take on this and other work. Overall, Mr Quinn believes that regulation of patient safety is still relatively "light touch" and that too many areas like hospital emergency departments are not getting proper scrutiny.
Hiqa's team can only stretch so far.
And the first onus on safety rests with the provider, he added.