Ms Angela Fitzgerald:

I thank the committee for the opportunity to present the key features of our 2022 annual report. I am joined by my colleagues Ms Máirín Ryan, deputy CEO and director of health technology assessment; Ms Carol Grogan, chief inspector of social services; Ms Rachel Flynn, director of health information and standards; and Mr. Sean Egan, director of healthcare. I will invite them to address questions relevant to their areas of expertise, with the committee's agreement.

I would like to take the opportunity to acknowledge the work of this committee in proposing changes and improvements in the way that health and social care services are delivered in Ireland. I took up the position of CEO of HIQA last year. During that time, I have been pleased to see some progress in a number of areas, particularly in the aftermath of the pandemic as services sought to reinstate normal activities and as we sought to reinstate our own normal business with regulated entities.

Our remit is expanding rapidly into new sectors and service areas. Over the coming years, we will see a significant expansion in the areas and sectors in which we have responsibility for regulation. That will bring opportunity and challenge. Right now, we are working to prepare for the commencement of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, which has been signed into law by the President. We hope it will be commenced in the coming months. The legislation will bring new responsibilities for HIQA in respect of the private hospital sector, which is welcome, particularly relating to notifiable incidents for all hospitals. I know the committee has a particular interest in that area. Other key areas of focus for HIQA are the preparation for the Human Tissue (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Bill 2022, the regulation and monitoring of home care services, and issues relating to international protection accommodation services, IPAS. A number of those issues have been considered by the committee.

One of the areas with which most people associate HIQA is the regulation of social services. The chief inspector within the authority is responsible under the Health Act 2007 for the regulation of designated centres for adults and children with disabilities, older persons and children's special care units. In 2022, more than 2,000 inspections were carried out across designated centres for people with disabilities, older persons' services and children's services. In our inspections over the course of the year, we were pleased to see the benefits for residents as Covid restrictions eased and normal activities were resumed. As outlined in our overview report on the regulation of disability centres, published on Monday, some providers used remote oversight arrangements during the pandemic, which we know had an adverse impact on overall compliance. We are working closely with providers to reinstate strong governance arrangements. We know from all the work we do that strong governance and management are a core requirement of safe service provision.

A key focus of our inspections is to ensure the rights of people living in residential services are respected and promoted. In the past year, since I took up this job, I have been asked to speak at a number of sessions. The message that has the greatest impact is around this particular responsibility of putting the rights of individuals who use our services at the centre of what we do. It is really important that we continue to promote that. We have seen from the data for 2022 that where centres have a good standard of care and support, it is underpinned by strong governance and management. While the majority of centres provide good care, there are some areas of concern. We continue to use the regulatory powers Ms Grogan has and the monitoring powers Mr. Egan has to drive improvements in the quality and care provided.

Members may be aware that in 2022, we commenced a new programme of inspections in acute and community healthcare settings against standards that have been available for a number of years, namely, the national standards for safer, better healthcare. In December, we published a report of our initial findings from the first seven emergency departments, EDs, we inspected. That report received considerable media and other focus. We sought to widen the debate around the core issues that impact on safe care in EDs. Specifically, we identified four areas as requiring immediate and longer-term focus. First is delivering on immediate and medium-term capacity requirements across the whole healthcare system. This committee has much to say about that. As members know, it is not just about acute beds; it is also about community provision. Another key point is the need for a more effective approach to strategic workforce planning to better anticipate and manage shortages or pressures on individual days. Our inspection process has sought to amplify that. As I mentioned, a key requirement is responsive leadership, governance and management arrangements at local, regional and national level that seek to address performance issues as they are identified and get upstream of and anticipate those issues. The fourth area, which is at the heart of what we do, is monitoring and managing patient safety risks.

As we moved into 2023, these themes remained central to our work. We have seen some good examples of improvements. However, a number of hospital EDs are failing to meet the requirements of the national standards because they remain overcrowded. The link between overcrowding and safety risk is well established. It must also be said that in those same hospitals, when we stepped beyond the emergency departments, we found examples of good practice in other areas. Tackling the factors that contribute to ED pressures is a core issue. In recent weeks, we published reports for Beaumont and Waterford hospitals, which are good examples of what good practice looks like. Throughout our work, we try to amplify what good practice looks like and what underpins it. From the work we have done, it is about three or four key things. It is about facilities having the appropriate capacity to do the work they are charged to do and having good systems and processes for managing demand and using that capacity effectively, particularly in the areas of managing elective and emergency patient flow. It is about the deployment of overall resources. Critically, it is about having good systems for measuring and evaluating performance. Through this work and the work in Ms Grogan's area, we continue to advocate on behalf of patients and the public with the aim of achieving a sustained improvement in these areas.

At the time I went for the job in HIQA, most people associated the authority with its regulatory role, which is very well understood. People probably understood a little less our role in health technology assessment, HTA. That has changed, which is welcome. The experience during the Covid period was that rapid HTAs were critical in informing decision-making and securing population understanding and buy-in. That particular role has been there from HIQA's inception and it is growing and becoming much more valuable in how we do our work. Ms Ryan is director of health technology assessment. We contribute to that area of work in a number of ways, of which we give more detail in the statement circulated to members. We contribute to the development of clinical guidelines and national clinical audit. We played a significant role in the work of the National Public Health Emergency Team, NPHET. In the past 12 months, we have contributed to HTAs that inform decision-making on childhood immunisation, the addition of severe combined immunodeficiency, SCID, to the newborn screening programme, metabolic surgery and the repatriation of paediatric stem cell transplant services. The scope of what we do is very wide. We recently published a number of evidence reports on long Covid. Some of that work has been the subject of discussion in the committee. We are contributing to a new public health strategy. We also contribute significantly on the international stage. Ms Ryan, in particular, is recognised as an international leader in Europe and beyond on evidence synthesis work, where we seek to learn from others about best practice and to embed that in the Irish health system. We are very proud that we are leading out in this area and we want to continue to do so.

Safe systems and effective healthcare are underpinned by standards. There is a lot of debate about where standards should be set, whether at the level at which they can be delivered or the level at which they should be. The view we generally hold is that we should seek to set the bar where it should be and support the system to get there. Ms Flynn and her team have a significant brief in the area of evidence-based standards. In the current year alone, we are seeking to finalise standards in the area of children's health and social services. That area is particularly interesting because we have taken an approach of following the child across all the settings. With the establishment of regional health areas, it is important that we look to make that join because children move between many different settings.

We are also charged with developing the standards for home support. One of the things we try to do in this regard is put in implementation tools. The phrase I use is that the game is played on grass, not on paper. It is really important that we work with providers to support them in implementing the standards.

HIQA has statutory responsibilities in the whole area of health information. We are very pleased to see the health information Bill is beginning to go through the various stages of development. We have been keen in calling for a standardising of the approach to health information. We have particular roles in the evaluation of the quality of information. We play a role in providing evidence to inform national policy. We are working closely at this time with the Department of Health on the health information Bill.

There has been much discussion about digital health. As a regulator, we in HIQA know the future of health regulation is data-driven, and technology is central to that.

We also know that digital health is central to being able to manage patients and users safely. We have a very important role, both nationally and internationally, in that space.

When we listen to when things go wrong, we learn that at the heart of it is how people experience the service. One of the important roles we have is listening and responding to service users. We have been part of a collaboration with the HSE, the Department of Health and advocacy groups through the care experience programme, which seeks to hear at first hand how patients and service users experience our services. The findings are very reassuring in the main - they show that the majority of people have a very good experience - but they also point to key areas of improvement, particularly as regards communication and supporting patients as they move through their journey. We have extended our remit. We did the first national patient bereavement survey, which required us to think differently about how we approach that. We also launched the national nursing home experience survey last year. That had very powerful findings for us as regards the experience of services. We are moving into end-of-life care, cancer and mental health.

Before I conclude, I will briefly touch on our values as an organisation. I have said already that a key theme in what we do is adopting a human rights-based approach. Members will see that right across the standards we develop, the guidance we produce and how we regulate health and social services. We also try to support the people who provide our services to understand this better. Almost 35,000 people went through our e-learning rights-based approaches, which is reassuring. An important part for us is to continue to engage with our stakeholders and to make sure that we are doing a good job and that those who use our services can continue to be heard. That is important for us because we have to sense-check everything we do with the people for whom we are responsible. We have learned a lot about our approach to that and we continue to change that. This process is part of that overall role as well. We see ourselves as having an important role in advocating for regulatory reform and a review of all the regulations relevant to our role. We are happy to talk about some of those here today.

We very much welcome the opportunity to be here and to share with the committee some of the experiences we have had in the past year and the work we are doing now. We thank Members for their time and look forward to taking any questions from them.