Health Bill 2006 Dáil Eireann Second Stage Speech by Mary Harney, T.D., Minister for Health and Children
Health Bill 2006
Second Stage Speech by Mary Harney, T.D., Minister for Health and Children
24 January 2007>
I move that this Bill be read a second time.
Introduction Dáil Eireann has been recalled one week ahead of schedule to begin the Second Stage of this critical Health Bill. It is a mark of the importance that members of the House and the Government give to legislation to set and enforce high standards of health care, particularly in residential settings.
Background This Bill represents a crucial element of the Reform Programme and is a new departure for the health services. For the first time, we are creating a body whose purpose will be to set quality standards and monitor enforcement of standards in an open and transparent way.
Step by step, in the reform programme and in legislation, we are leaving behind the old system. That system included, for too long, inconsistent standards across health boards, opaque standards, incomplete standards and even no standards. It gave us inconsistency of enforcement, some legal incapacity for enforcement of residential care standards, and gaps in the scope of enforcement in these settings. We are also leaving behind the old system where vital information in health was not comprehensively gathered, and assessment of new technologies and new drugs was not clearly and systematically made to serve the interests of patients and taxpayers alike.
The Bill establishes the Health Information and Quality Authority incorporating the Office of the Chief Inspector of Social Services. This was a commitment in the Government’s Health Strategy, Quality and Fairness.
Let me assure the House that the preparatory work has been carried out by interim HIQA, so that as soon as the legislation is enacted, it will be ready to use its powers.
So, very soon, there will be a fully independent inspectorate for all nursing homes for older people, both public and private, as well as for centres for people with disabilities and children. HIQA has very strong powers. It will set national standards and the Chief Inspector will inspect residential facilities against these standards. Where necessary the Bill provides for action to be taken quickly to protect service users. This includes provisions for the urgent closure of centres. There will no longer be any issue about the legal capacity to shut down urgently a failing nursing home or residential care centre.
Registration and inspection requirements will apply equally to HSE residential centres, centres operated by agencies funded by the HSE and private nursing homes, guaranteeing that the public, voluntary and private sectors providing residential services are required to meet the same standards of care.
The Chief Inspector will also be responsible for overseeing standards in foster care for children, pre-school services and what is called in law the ‘boarding out’ of older people, where they reside in someone’s actual home. The Social Services Inspectorate (the SSI) has been operating on an administrative basis since 1999 conducting inspections into children’s residential services run by the HSE under the statutory powers contained in section 69 of the Child Care Act 1991. Even within the confines of the existing legislative framework the Inspectorate has played a major role in developing and enforcing high standards in child welfare and protection services.
Commitments to provide for the SSI’s establishment on a statutory basis were given in the Health Strategy and were restated in the current social partnership agreement, Towards 2016, as were commitments to extend the SSI’s remit to residential services for older people and people with disabilities.
These commitments are being met in the Bill by the establishment of the Office of the Chief Inspector of Social Services within HIQA, with specific statutory functions. This office holder will take on the SSI’s current inspection work and will also register and inspect residential services for people with disabilities and for older people, including private nursing homes.
It is essential that mechanisms and structures are in place to audit that quality together with an independent system for continuous performance review to ensure consistently high standards.
Alongside this Bill, I would like to confirm to the House that I am establishing a Commission on Patient Safety and Quality Assurance to examine and make recommendations on a system of licensing for all public and private providers of health care. That will include hospitals, public, private and voluntary. It is the direction we must take to give patients the greatest possible assurances of safe and quality care.
Role of Health Information and Quality Authority (HIQA)
In brief the functions of the Authority will be to:
- Set standards on safety and quality for all services provided by the HSE and service providers on behalf of the HSE, and private nursing homes, with the exception of mental health services which are covered by the Mental Health Commission and the Inspector of Mental Health.
- Monitor compliance with the standards it sets and advise the Minister and the HSE on the level of compliance.
- Undertake investigations as to the safety, quality and standards of services where the Minister believes that there is serious risk to the health or welfare of a person receiving services.
- Carry out reviews to ensure best outcomes/value for money for the resources available to the HSE.
- Operate accreditation programmes of health and personal social services in both the private and public health sectors.
- Carry out assessments of health technologies, including drugs and medical devices.
- Evaluate information available on services provided by the HSE and other service providers and on the health and welfare of the population, identify information deficiencies, and advise the HSE and the Minister accordingly.
- Set standards (including governance arrangements) for the HSE and service providers in relation to information and data in their possession on health and personal social services and on the health and welfare of the population and advise the Minister and the HSE on the level of compliance with the standards.
HIQA will now have a central role in health information development and the implementation of the recommendations set out in the National Health Information Strategy.
Office of the Chief Inspector of Social Services
I said earlier that the Bill also provides for the establishment of the Office of the Chief Inspector of Social Services. The Chief Inspector will be an employee of HIQA with independent statutory functions. These are to
- inspect and register residential centres, both public and private, for older people, people with disabilities, and children and inspect special care units for children
- oversee the performance of the HSE of its functions under sections 39, 41 and 53 of the Child Care Act 1991 in respect of standards in fostering and pre-school services and section 10 of the Health (Nursing Homes) Act 1990 in respect of boarding out of elderly people, and act as an authorised person for the purposes of section 185 of the Children Act 2001 as amended by the Criminal Justice Act 2006 – act as an authorised person for the purposes of section 185 of the Children Act 2001, as amended by the Criminal Justice Act 2006. This means that the Chief Inspector will inspect, at least once every twelve months, each Children Detention School under the administration of the Irish Youth Justice Service of the Department of Justice, Equality and Law Reform.
The Bill sets out inspection and registration requirements for residential centres. A rigorous and robust inspection system is being set in place. Centres will be inspected against standards set by HIQA and regulations made by the Minister. The Chief Inspector will have extensive powers in carrying out inspections and may enter a centre, examine any records, take copies of documents and inspect and remove other relevant items. The Chief Inspector can also interview staff in private and interview residents.
Residential centres may not operate unless they have been registered by the Chief Inspector and it will be an offence to operate without registration. A centre must be in compliance with conditions of its registration. Registration details will be available to the public on the Internet.
The Chief Inspector can cancel a registration if the residential centre fails to meet standards. An urgent cancellation of registration can be sought by the Chief Inspect from the District Court if the Chief Inspector believes there is a risk to the life, or a serious risk to the health or welfare of people resident in a centre.
Principal Features of the Bill
Preliminary matters Turning now to the details of the Bill itself, Part 1 (Sections 1 to 5) contains standard provisions dealing with short title, interpretation, commencement, establishment day and expenses.
Health and Information and Quality Authority
Part 2 (sections 6 to 11) makes provision for the establishment of Health Information and Quality Authority, details its functions, which I have already outlined, and contains provisions required for its operation and other matters.
In line with arrangements for other statutory agencies responsible for setting standards and monitoring compliance, section 9 provides that standards set by HIQA must be approved by the Minister. Section 10 provides that the standards will be admissible as evidence in court proceedings and Section 11 allows the HIQA to require information from the HSE and service providers. It should also be noted that under the regulations the Minister will be able to set out the procedures to be adopted by the Authority in setting standards. This is to ensure that the appropriate statutory bodies are consulted before standards are drawn up.
Board of the Authority
Part 3 (Sections 12 to 19) provides for the establishment of HIQA Board and related matters. The Board will have 12 members.
Chief Executive Officer of the Authority
Part 4 (Sections 20 to 24) are standards provisions dealing with the appointment of the Chief Executive Officer.
Employees of the Authority
Part 5 (Sections 25 to 27) are also standard provisions dealing with the recruitment of employees and advisers.
Accountability and Funding
Part 6 (Sections 28 to 38) deals with the accountability and funding of the Authority. Section 28 allows the Minister to give the HIQA general directions so that Ministerial policy will be clear. HIQA is required to prepare a five year corporate plan under Section 29. Sections 30 and 31 provide for grants to HIQA and submissions of a business plan. Under section 31, HIQA must draw up a code of governance which it must submit for the Minister’s approval. Section 33 is a standard provision regarding the Authority’s accounts. Section 35 provides that HIQA may accept gifts under certain conditions. Section 36 obliges the Authority to submit an annual report to the Minister. Section 37 allows the Authority to assist other bodies which are carrying out functions similar or ancillary to its own. Under section 38, HIQA may charge for any services it provides except those that it provides to the Government, HSE or public service providers. This will enable it to be in a position to charge for advice on safety and quality which might be requested by private service providers.
Office of the Chief Inspector of Social Services
Part 7 (Heads 39 to 44) deals with the Office of the Chief Inspector of Social Services. Section 39 establishes the Office and section 40 sets out the functions of the Chief Inspector. These are the inspection and registration functions I outlined earlier. Section 41 provides for the attendance of the Chief Inspector before an Oireachtas Committee to give a general account of the activities of the Office of the Chief Inspector. Section 42 provides for the appointment of assistant inspectors. I should mention at this stage that section 70 allows HIQA, at the request of the Chief Inspector, to also appoint qualified persons to assist the Chief Inspector and inspectors in regard to inspections of residential centres. Section 46 deals with the corporate and business plans for the office of the Chief Inspector and their inclusion in HIQA’s corporate and business plans.
The HSE currently carries out inspections of voluntary children’s residential centres and private nursing homes. The legislation provides that these will become a statutory function of the Chief Inspector. Section 44 provides that the Minister may require the HSE to carry out these inspections on behalf of the Chief Inspector. This is intended as a temporary arrangement to facilitate the continued inspection of these facilities pending a transfer of staff and resources to the Authority. Inspections must be carried out in the manner specified by the Chief Inspector and in accordance with standards set by HIQA and regulations made by the Minister.
Regulation of designated centres
Part 8 (sections 45 to 67) deals with the registration of residential centres for older people, including private nursing homes, people with disabilities and children in need of care and protection. These centres are known as designated centres in the Bill.
Under section 45 a person shall not carry on or manage a designated centre unless the centre is registered and person is the registered provider. A person is prohibited from managing a designated centre if the centre isn’t registered. Any person applying for registration or renewal of registration is prohibited from giving misleading or false information under section 46. Sections 47 and 48 deal with requirements in regard to applications for registration and the details to be included by the Chief Inspector on the registers he or she maintains. The registration of a designated centre is for 3 years.
Section 49 provides for the granting or refusing of applications for registration. The Chief Inspector will grant the application if satisfied that the registered provider and any other person involved in the management of the centre is a fit person and the centre complies with standards set by HIQA and regulations made by the Minister. If the Chief Inspector is not satisfied on these counts, the application will be refused. The Chief Inspector may attach conditions to registration.
Under section 50, the Chief Inspector can cancel a registration or vary a condition of registration or impose new conditions if certain circumstances. These circumstances are where the registered provider or other person involved in the management of the centre is convicted of particular offences, is not a fit person or where the centre is not meeting its regulatory requirements. Registered providers may apply to the Chief Inspector to vary a condition of registration under section 51.
Sections 52 and 53 provide for notification by the Chief Inspector of proposed decisions and the right to respond. The Chief Inspector must give notification of proposed decisions to refuse or cancel registration, vary or attach conditions of registration or impose new conditions. Time is allowed for the making of written representations.
Section 54 provides that when the decision is made by the Chief Inspector, the person is informed in writing of the decision. Section 55 sets out certain requirements and prohibitions in relation to designated centres. Section 56 provides for the right of appeal, on the part of a registered provider or applicant, to a decision by the chief inspector to the District Court. Appeals must be brought within 28 days after receipt of a written notice from the chief inspector.
The Bill provides for the urgent cancellation or varying of conditions of registration where the Chief Inspector believes that there is a serious risk to the health or welfare of residents. Sections 57, 58 and 59 set out the procedures and arrangements in this regard. The Chief Inspector must apply to the District Court for an order in regard to the registration and this application may be may ex parte and without notice to the registered provider. An ex parte interim order may be granted by the Court if the Court considers it necessary or expedient to make the order immediately in the best interests of the residents. The Chief Inspector may apply to the Court for a final determination. Notice of this application must be given to the person who was the registered provider at the time of the ex parte application. The Bill provides for appeals of District Court decisions to the Circuit court under section 60.
The Chief Inspector must notify the HSE immediately when registration is cancelled and the Executive must make alternative arrangements for residents.
Sections 64 to 66 are technical provisions dealing with matters related to the closure of designated centres and the appointment of persons by law to take charge of a centre.
Section 67 sets out the transitional arrangements for existing designated centres to allow them to operate pending registration for a period of not more than three years.
Investigations and Inspections
Part 9 (sections 68 to 75) deals with investigations by HIQA, inspections by HIQA for the purposes of monitoring compliance with standards set and inspections of designated centres by the Chief Inspector of Social Services. Section 68 allows HIQA to appoint persons known as “authorised persons” to monitor compliance with standards set and to carry out investigations where the Minster believes there is a serious risk to the health or welfare of a person receiving services. Section 71 gives authorised persons right of entry to premises owned or controlled by the HSE or service provider. An authorised person may inspect and take copies of relevant documents and inspect any other relevant item and remove it from the premises. All information required by the authorised person must be given even if the records are held away from the premises in question. Authorised persons may interview staff in private. They may also interview service users, present or former, with their consent. The Chief Inspector, in respect of inspections of designated centres, has precisely the same powers as authorised persons.
A warrant may be obtained from the District Court if an authorised person or, as the case may be, the Chief Inspector is prevented from entering a premises or believes there is a likelihood of being prevented from entering a premises. In these circumstances, an authorised person or the Chief Inspector may be accompanied by a member of the Garda Siochana. It will be an offence to refuse, obstruct or give false or misleading information to an authorised person or the Chief Inspector.
Provision is also made for entry to a private residence if necessary. This requires the consent of the occupier or a warrant from the District Court.
Section 69 provides that the HSE may appoint persons to examine designated centres in certain circumstances.
Part 10 (sections 76 and 77) provides for the offences under the Bill and the proceedings for summary prosecutions. A person guilty of a summary offence is liable to a fine of up to €5,000 or a term of imprisonment of up to 12 months or both. A person guilty of an indictable offence is liable to a fine of up to €70,000 or a term of imprisonment of up to two years or both.
Standards, Disqualifications, Etc
Part 11 (sections 78 to 82) contains the standard provisions for Board members, employees and advisors in relation to standards of integrity, codes of conduct and prohibition against unauthorised disclosure of information and the standard disqualifications from Board membership and employment.
Dissolution of certain bodies
Part 12 (sections 83 to 94) provides for the dissolution of the Irish Health Services Accreditation Board and the Interim Health Information and Quality Authority and the transfer of their employees to HIQA.
Part 13 (Sections 95 to 99) provides for the general power to make regulations and specific powers to make regulations regarding registration arrangements and standards in designated centres. Regulations may also be made on the procedures to be followed by HIQA in setting standards under section 7.
Consequential and Minor Amendments to Other Acts
Part 14 (sections 100 and 101) provides for consequential amendments to other Acts and the revoking of orders.
Schedule 1 sets out the Acts repealed and the orders revoked. Schedule 2 sets out the amendments to other Acts.
Views of Interest Groups
In line with guidelines on Regulatory Impact Analysis, a public consultation process on the legislative proposals was undertaken last year. Over 70 submissions were received and the proposals to establish HIQA and the Office of the Chief Inspector of Social Services were generally welcomed. I should add that there has also been extensive discussion with Interim HIQA and the SSI in respect of the Bill. The key features of the Bill reflect the outcome of those consultations and I am confident that the Bill has been improved and strengthened as a result.
Before I finish, I would like to outline the substance of an amendment I propose to bring at Committee Stage. I am deeply conscious of the public concern and concerns expressed in this House regarding the level of protection provided to employees in the health service who raise issues concerning the safety and welfare of patients. In line with a commitment I gave last year, I will be introducing specific provisions in the Health Bill regarding the protected disclosure of information. These provisions will support the existing statutory frameworks governing health professionals and those in the recently published Medical Practitioners Bill.
This Health Bill is a central part of the Government’s Reform Programme for the health service. I believe the establishment of HIQA and the Office of the Chief Inspector of Social Services will bring about a safer health and social services system which embeds quality at all levels and in all settings. We are learning from the past, and leaving the past behind. This Bill will put in place an essential part of the 21st century health service in Ireland.
I commend the Bill to the House and look forward to hearing the views of Deputies.