Understanding HIQA when caring for Patients in Long Term Residential Care from the GP’s perspective
What is HIQA?
HIQA is a statutory body established to drive continuous improvement in Ireland’s health and social care services. It is responsible for the registration and inspection of all residential care services for older people. Residential care services are required to meet certain standards, which are set out in legislation and include rules about the standard of accommodation and care that is expected. All residential care services, including public, private and voluntary nursing homes are subject to this independent registration and inspection. HIQA and its powers are governed by the Health Act 2007.
HIQA has published the “National Quality Standards for Residential Care Settings for Older People”, which sets out the standard for quality safe service for an older person living in residential care.
Inspectors use these standards and the legislation to check that residents in nursing homes are safe and well looked after. Inspections provide information to residents, their families and the general public about the standards of care in individual nursing homes. The aim of the inspection is to make sure that poor services are not allowed to operate and to support those nursing homes that provide good, person centred, care.
Inspectors will talk with managers, staff and interested people and they will also talk with residents and their families. Thereafter they will produce inspection reports which give factual information and highlight where standards of care are well met as well as where improvements are required.
The Health Act 2007 provides HIQA with the power to seek legal enforcement of their recommendations and sanctions in the event of non-compliance. Under the legislation nursing home staff and service providers like GPs must co operate with inspectors as Section 77 of the Act provides that a person must not obstruct or impede an investigation or give false or misleading information and penalties for non-compliance include a fine and/or imprisonment.
The effect this has on GPs depends on where they maintain their records for patients in long term residential care. Some will keep their records on the patients Nursing Home chart and in this regard these records can come under inspection.
Inspecting records -V- Duty of Confidentiality
Many health practitioners are surprised that HIQA have the power to review patient medical records. The general principles regarding disclosure of patient’s medical records is that disclosure can only be made with the patient’s consent except:-
- When directed by the Court
- When necessary to protect the interests of the patient
- When necessary to protect the welfare of Society/public interest
- Disclosure to other health care professionals.
However, HIQA’s power to review records does come within these exceptions. Nursing home residents are seen as ‘vulnerable persons’ and therefore HIQA’s role is seen to be necessary to protect the welfare of society/public interest. Section 73 of the Health Act 2007 states HIQA inspectors:
“may, inspect, take copies of or extracts from and remove from the premises any documents or records (including personal records) relating to the discharge of its functions by the executive or to the services provided by a service provider”
Strict interpretation of the Health Act 2007 would suggest that GP records cannot be inspected as it is only records relating to the discharge of the service providers functions. However, if the GP works under the umbrella of the Nursing Home then their records will be liable to inspection. Furthermore, as highlighted above, if the GP maintains his records on the patients nursing home chart they are also likely to be open for inspection.
While this power overrides the duty of confidentiality and can be criticised for stifling practitioners as they provide care to their patients one must remember the overall goal of HIQA is to continue to improve health and social care services in Ireland.