GUIDELINES ON THE USE OF THE MENTAL HEALTH (NORTHERN IRELAND) ORDER 1986

The Role of the Regulation AND QUALITY IMPROVEMENT Authority (part VI)

The Role and function of RQIA What is RQIA? The Regulation and Quality Improvement Authority (RQIA) is Northern Ireland's independent health and social care regulator.

RQIA is the independent body responsible for monitoring and inspecting the availability and quality of health and social care services in Northern Ireland, and for encouraging improvements in the quality of those services. Why was RQIA established? RQIA was established in April 2005 under The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003. This created the legal framework for raising the quality of health and social care services in Northern Ireland, and extended regulation and quality improvement to a wider range of services.

Since April 2009, under The Health and Social Care (Reform) Act (Northern Ireland) 2009, RQIA has undertaken the functions under the Mental Health Order (NI) 1986 which were previously carried out by the Mental Health Commission.

What are the primary functions of RQIA? RQIA's main functions are:

  • To inspect the quality of services provided by health and social care (HSC) bodies in Northern Ireland through reviews of clinical and social care governance arrangements within these bodies
  • To regulate (register and inspect) a wide range of services delivered by HSC bodies and by the independent sector. The regulation of services is based on legislative requirements and minimum care standards to ensure that service users know what quality of services they can expect to receive, and service providers have a benchmark against which to measure their quality
  • Since 2009, to have specific responsibilities for people with a mental illness and those with a learning disability. These include; preventing ill treatment, remedying any deficiency in care or treatment, terminating improper detention in a hospital or guardianship and preventing or redressing loss or damage to a patient's property.

What services does RQIA inspect? RQIA inspects a wide range of statutory, voluntary and private health and social care facilities. These include:

  • Nursing and residential care homes
  • Children's homes
  • Day care settings
  • Independent hospitals and clinics
  • Domiciliary care agencies

RQIA also has a programme of inspection to examine infection prevention and control in health and social care facilities, including hospitals, and a programme of inspection at mental health and learning disability services across Northern Ireland. How are inspections carried out? RQIA's inspections are carried out by professionally qualified inspection staff including nurses, social workers and allied health professionals. Inspections are based on service specific regulations and minimum standards.

During inspection RQIA examines the:

  • Quality of care
  • Quality of life of the residents
  • Quality of management
  • Quality of the environment

These focus on encouraging improvement in the quality of services to ensure they are safe, accessible, well managed and meet the required standards. Good practice is highlighted and shared. All inspections use a human rights based framework. How does RQIA encourage improvement across services? Where areas of improvement are identified, RQIA will inform the Registered Person/ Manager of its views, and agree with them what remedial action is required to improve the service and to ensure the safety of service users.

Following an inspection RQIA asks the service provider to make any changes considered necessary through a quality improvement plan (QIP) and this information is published in a report, available on the RQIA website.

Enforcement action is an essential element of the responsibilities of RQIA under The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003, and is central to the aim of RQIA to protect service users and bring about sustained improvements in the safety and quality of service provision. RQIA ensure that all enforcement activity is targeted, proportionate and consistent.

This includes the issue of notices of failure to comply with regulations, placing conditions of registration, imposing fines, or closing a service. RQIA - Mental Health and Learning Disability How does this include people with mental illness or learning disability? RQIA has both general inspectorial and specific statutory functions that protect people with mental illness and learning disability.

Inspection of services

Under The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003, RQIA has a specific function of reviewing mental health and learning disability services across Northern Ireland.

This includes:

  • Conducting reviews into the monitoring and improvement arrangements
  • Carrying out investigations and inspections
  • Recommending actions for improvement
  • Reporting unacceptably poor quality or significant failings to the DHSSPS

The visiting programme includes annual announced and unannounced reviews and inspections of mental health and learning disability hospitals, community care and treatment facilities.

Statutory functions

In 2009, RQIA established a multi-professional Mental Health and Learning Disability Team to take specific responsibility for the statutory requirements in Part VI of the 1986 Order.

The Mental Health and Learning Disability Team works closely with the other teams in RQIA as some aspects of the general care and treatment of persons with mental illness or a learning disability are included in their inspection and monitoring functions. What are RQIA's responsibilities under the Mental Health (Northern Ireland) Order 1986? Under the Mental Health (NI) Order 1986 and following the transfer of responsibilities of the Mental Health Commission under The Health and Social Care (Reform) Act (Northern Ireland) 2009, RQIA now has specific responsibility for keeping under review the care and treatment of patients with a mental disorder.

In taking on this responsibility RQIA takes an approach that is independent, multidisciplinary, and protective, with investigative, inspectorial and advisory functions. In particular, RQIA will:

  • Inquire into cases where there may have been ill-treatment or deficiency in care and treatment, improper detention in hospital; improper reception into guardianship of a patient, or where the property of a patient may have been exposed to loss or damage
  • Visit and interview detained patients in private
  • Advise the relevant authorities of steps to be taken to secure the welfare of a patient, or any matter concerning the welfare of a patient
  • Inspect a patient's records and their movements within mental health and learning disability services

How does RQIA carry out these responsibilities? RQIA established a dedicated mental health and learning disability (MHLD) team responsible for inspecting and reviewing mental health and learning disability services across Northern Ireland.

The MHLD team includes:

  • Mental Health Officers from a range of professional health and social care backgrounds.
  • Administrative staff with responsibility for scrutinising documents, including: forms in relation to application for admission; detention for assessment and treatment; and guardianship.

Are there protections for all patients with a mental disorder? Yes, for all persons with a mental disorder: (Article 86(1))

  • The Inspection programme across inpatient and community settings uses specially developed human rights based principles and "Expectation standards" This process enables providers to produce a Quality Improvement Plan and allows issues of concern to be raised and dealt with at the appropriate level in the health and social care system. These reports will be published on the RQIA website
  • Specific Reviews of Mental Health and Learning Disability Services and Issues are undertaken either as part of the RQIA commissioned Reviews or as part of the RQIA 3 year programme of Reviews

This allows a focussed review of relevant ongoing and emerging areas of concern, e.g. children in adult services.

Are there specific protections for persons with a mental disorder? Yes, for persons detained or under guardianship under Part II of the Order

  • To visit and interview detained patients in private Article 86 (2) (b) The MHLD Team have developed a programme called the Patient Experience Review which was informed by consultation with service users and advocates and is based on Human Rights principles. Annual visits are made by Mental Health Officers and all detained patients are offered the opportunity to engage. Their views regarding care are incorporated into the inspection process and improvements recommended where necessary.
  • To appoint doctors to carry out specific functions in relation to detention in hospital for assessment and treatment and guardianship (Part II) and safeguards for treatment under the Order (Part IV)

How does RQIA review the exercise of the powers and the discharge of duties conferred or imposed by the Order?

  • The Mental Health and Learning Disability team scrutinize all detention and guardianship forms to ensure that they comply with the Order.

See Scrutiny and Rectification of Documents Appendix for full details.

  • A Guardianship Panel meets to review and scrutinize the information relating to the welfare grounds required and to ensure that the process meets all the requirements of the order. The MHLD team works closely with other regulatory teams to enhance the scrutiny of care and treatment of persons under guardianship in community facilities that are inspected by RQIA.
  • RQIA holds a register of all Part II and Part IV doctors and Approved Social Workers to ensure that those professionals involved in restrictive measures under the Order are approved to do so.
  • "To bring to the attention of the relevant authorities the facts of any case to secure the welfare of a patient". Article 86 (2) (c,d & e)

    This includes a wide range of issues of care, treatment, management of finance etc which are most likely to be identified through the review and inspection programmes but may come to attention in a number of ways including through concerns raised by staff or families.

    In addition, a Multidisciplinary panel reviews all Serious Adverse Incidents and ensures that appropriate action has been taken.
  • RQIA may refer to the MHRT the case of any person who is liable to be detained or under guardianship, Article (3) (a), if it considers that there are legal issues that require examination.

What is RQIA's role in relation to prisons ? On 1 April 2009 the responsibility for the provision of healthcare was transferred from the Northern Ireland Prison Service to Health and Social Care Services. Services are now commissioned by the HSC Board and provided by the South Eastern Health and Social Care Trust. This transfer of responsibility brought health services for people detained in prison under the remit of RQIA.

RQIA has commenced a programme of inspection of prison healthcare which has been carried out in partnership with Criminal Justice Inspectorate Northern Ireland (CJINI), Her Majesty's Inspectorate of Prisons (HMIP), and the Education and Training Inspectorate Northern Ireland. RQIA inspections will include consideration of services for people with a mental illness and learning disability.

RQIA has a separate role in relation to the Optional Protocol to the Convention against Torture (OPCAT) as one of a number of organisations who have been given responsibility as a National Preventive Mechanism (NPM) for people in detention.

Can any member of the public, including people with a mental disorder and their carers contact RQIA regarding care and treatment?

  • The Mental Health and Learning Disability Team is accessible for all service users and their carers to contact by telephone for advice or to discuss aspects of their care. This information is documented and informs the overall process of monitoring the quality of care provided. Unannounced inspection may be arranged to investigate serious concerns.
  • Training and information sessions are provided to the public, Health and Social Care Trusts and professional and voluntary bodies as a means of promoting shared learning and best practice.

How does RQIA include and support service users?

  • Service users and advocates were consulted and shaped the development of the Patient Experience Reviews.
  • The Mental Health and Learning Disability Team works closely with independent advocacy services to assess the level of provision for service users and to ensure inclusion in planning and delivery of the service RQIA provides.

To learn more or to obtain contact details please go to the RQIA website- www.rqia.org.uk