Evidence from Older People’s Commissioner for Wales – HIW 14

Text Box: Committee Clerk Health and Social Care Committee National Assembly for Wales Cardiff Bay, CF99 1NA

19 September 2013

Inquiry into the work of Healthcare Inspectorate Wales

I welcome the way that HIW’s approach to inspection and regulation has developed over the last five years with its increased focus on the experiences of patients when using healthcare such as it Dignity and Essential Care spot checks. I was pleased that the staff from the Older People’s Commissioner were involved in the development of this approach and that HIW was able to draw on the information and knowledge from the Commissioner’s report on Dignified Care? published in 2011. I also welcome the commitment made by HIW to embed human rights into all of its inspection and regulation activities.

HIW also continues to assess the ‘fitness’ of health care providers more generally such as through its work on the Standards for Health Services. All NHS organisations are required to self-assess against these and has to complete an annual Governance and Accountability self-assessment that deals with its overall governance systems and practices. HIW then uses information from its various inspection activities to corroborate these self-assessments together with information from other regulation, audit and inspection bodies.

This ‘system’ assurance approach coupled with a clear focus on the patient’s experience is potentially a very powerful way of providing assurance that not only are health organisations governed well but that this works in terms of the treatment and care that patients’ receive.

HIW has for a number of years now established and facilitated an annual programme of healthcare ‘summits’ in order to share information and intelligence about Welsh NHS organisations. The approach and methodology of the ‘summits’ have developed over the past few years to include various other external ‘scrutiny’ bodies such as the Older People’s Commissioner. This has been very welcome and mutually beneficial.

In many ways HIW has developed and led approaches to inspection ad regulation in Wales that are not only significantly different to those used in England over the past few years but also anticipated and pre-empted the criticisms made in the Francis report on Staffordshire Hospital about the failure of the inspection and regulation regime in England to focus on the things that mattered or to share information with each other about healthcare providers. HIW has, in my opinion, led the way across the UK in establishing and developing systems of information and intelligence sharing as part of a more holistic assurance framework for the NHS.

While I am therefore of the general view that the way in which HIW has evolved and developed is the correct combination on focusing on healthcare organisations and the experience of patients using healthcare, there is scope for much more to be done by HIW in this respect.

I would like to see HIW setting out clearly how over the next three years it will further develop its inspection and regulation approaches, especially in response to the Francis Report and the Welsh Government’s response in July. This would be of benefit to all concerned: patients, carers, the public, Ministers and AMs and healthcare staff.

I would also like to see how HIW will take forward the development of an integrated and comprehensive assurance framework for healthcare in Wales as stated in the Welsh Government’s response to the Francis report. I would expect that the proposed framework will be consulted on and I look forward to making a significant input to its development. I see this single assurance framework as the most important development in the whole area of external inspection and scrutiny of the NHS that has happened in the last decade and it is an approach where Wales can lead the UK. I will also want to make sure that the issues I have identified in my Dignified Care? Report and my follow up reports are embedded in this framework and reported on annually. I have agreed with Welsh Government that this action will be taken.

I believe it is important that HIW and the other inspection, regulation and audit bodies in Wales now move swiftly to publishing a single annual assurance statement about healthcare providers in Wales. This, alongside the Annual Quality Statement, should go a long way to ensuring that healthcare in Wales is of the highest level of safely and quality and is being provided in a way that is both compassionate and respects the dignity of patients. The information in the single assurance statement will of course need to be presented in a way that is easily understood by the public so that they can regain assurance about the NHS (something that sadly has been eroding over the last few years) and also that where failures or weaknesses are identified they can see clear evidence of improvement.

Finally, I would like to raise the issue of HIW’s capacity to deliver its important and growing work programme. The world of inspection and regulation has evolved very rapidly since HIW was establish in 2004 and the Committee’s inquiry is a welcome opportunity to review HIW’s capacity and capability and to make recommendations for strengthening HIW if this is indicated by its review.

Yours sincerely

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Sarah Rochira

Older People’s Commissioner for Wales