Sir, – At a time when the governance and inspection of nursing homes is rightfully under scrutiny, spare a thought for the role of the Health Information and Quality Authority (Hiqa) inspector. To set some context for readers, Hiqa carries out inspections of all nursing homes in Ireland to assess compliance with the regulations and standards. While inspections are normally unannounced, a centre can expect at least one announced inspection in the three-year registration cycle. While it is undoubtedly a critical job to determine whether a residential centre is compliant or not, the level of guidance provided by Hiqa appears mind-boggling. Guidance on each individual regulation from numbers three to 34 is described in immense detail in a 124-page guide with the inspection covering various aspects of capacity, capability, quality and safety.
Interestingly, while individual care plans are a key tenet of individual personalised care, according to Hiqa, nursing homes in Ireland are free to use a variety of different care-plan templates.
This lack of consistency must make the job of the inspector even more challenging. While I am reluctant to add to the already overburdened inspector’s workload, I am surprised that “quality of life” does not appear to feature in the inspection metrics and is only vaguely referred to in reports. It might seem a grandiose title, but I think we all know the elements that make us happy – autonomy to get up and go to bed when we choose, receive family and friends whenever we want, have a choice of good food, be empowered to indulge our interests and our hobbies, enjoy a certain level of privacy, etc. While clinical excellence and infection control are of course important, we cannot forget the importance of living a good life. While it is true that Hiqa inspectors do speak to some residents and relatives for some qualitative feedback, the interviewees are typically selected by the nursing home, which inevitably tends to favour those who are uncritical in their comments.
In summary, I have a new-found respect for the poor inspector but wonder whether they have been dragged so far down into the minutiae that they cannot possibly see the wood for the trees. It has also led me to question if Hiqa’s remit has become too broad. What started as a dedicated focus on older-person care has gradually expanded over the years to incorporate children’s services, disability services and acute and community healthcare services. While these are equally important areas, they too deserve their own undiluted focus. – Yours, etc,
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ANNETTE CONDON,
Cahir,
Co Tipperary.