Community Practitioners' and Health Visitors' Association

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The Community Practitioner’s and Health Visitors Association’s response to Best Practice – Best Care Consultation Paper (Northern Ireland)

The CPHVA welcomes the opportunity to respond to this Consultation Paper. Views were sought from community practitioners from a range of community nursing backgrounds to contribute to this response. Improving the quality of health service provision to our client population is of paramount importance to all community nurses and health visitors and we therefore welcome the Government’s commitment to addressing this issue.

Section 3

Do you consider the service development framework approach should be developed?
Yes. The service development framework approach provides a structured method encompassing evidence based practice guidelines, standards and user involvement in providing a quality service for the population. How can user involvement be best secured in the development of service development frameworks? It is important to ensure that users are represented on the various committees responsible for policy decision-making including the new Health and Social Care Groups. Community and voluntary groups should be widely consulted, particularly in relation to frameworks specific to their field of practice. Users should also be encouraged to respond via the Internet before any decisions are finalised. What services should be considered for development using a service framework approach? The services that the Government have identified as priorities in the Investing For Health document are those that should be initially targeted for developing this approach.          

3.6 – 3.20 Does there need to be a local focus to disseminate and produce guidelines and standards for the HPSS? It would be a waste of scarce resources to replicate the work of organisations such as NICE here in Northern Ireland and therefore option 3 would appear to be the most appropriate option. Most of the service requirements are similar here to those in the rest of the United Kingdom but there is still a need to have a local focus to interpret and disseminate them at regional level. It is important also that there would be user and other relevant organisation representation on any committee set up to decide on any framework specific to the needs in Northern Ireland. The parameters set out in 3.11 appear to be appropriate. How can users best be represented on any group set up to produce specific standards and guidelines for the HPSS? Nominations should be sought from community and voluntary organisations to sit on committees that are developing standards specific to their particular field of expertise and practice. Focus groups consisting of various representatives from a range of organisations both statutory and voluntary could also be used to elicit the opinions of user and relevant others. Those bodies already in existence i.e. CREST and RMAG could be brought under the umbrella of any new local arrangement to facilitate future close collaboration and make best use of the expertise already availabl

Section 5   Do you consider the duty of quality should be placed on those services commissioned by an HPSS Trust?
Yes. However it is essential that services are adequately resourced or it will not be possible to improve them. The levels of staffing in school nursing and health visiting in many Trusts are low and this mitigates against improving standards and quality. There needs to be equity of staffing across Trusts otherwise it will be impossible to ensure regional standards are met In view of the Independent nature of Family Health Services Practitioners, how best can clinical and social care governance be applied in primary care? Part of the function of Local Health and Social Care Groups should be to ensure that clinical and social care governance arrangements are in place in all services commissioned by them including those provided by Family Health Services Practitioners. The proposals set out in the document "Confidence in the Future" should, if implemented, help to ensure that the right conditions are in place for doctors to provide a quality service to their patients. Do you consider that this system of clinical and social care governance will help to improve the quality of services? The emphasis on moving away from a culture of blame to one of learning is welcomed. However, this message may be difficult to get across to some managers who in the past have been quick to scapegoat staff rather than take responsibility for providing the necessary support and supervision to ensure the safe delivery of care. Health care staff will need to be supported in adapting to new technology e.g. information computer technology if they are to be able to access and disseminate information on research and evidence based practice. Arrangements for appropriate staff supervision should be formalised in every Trust so that Continuous Practice Development becomes a reality. Should the statutory duty of quality of services be placed on an HSS Trust for the services it commissions as well as those it provides? The HSS Trusts should have some mechanism in place for monitoring the quality of services it commissions from other agencies. If the quality of services provided by other agencies is not of an acceptable standard then that Trust should have responsibility to either get the service elsewhere or assist in getting the service up to standard.   How best do you think clinical and social care governance principles can be applied in primary care? A person should be appointed from each of the main professional groups of service providers to ensure that clinical and social care principles are taken forward. These people should report regularly to the person with responsibility within the Local Health and Social Care Groups for clinical and social care governance arrangements. Sanctions should be imposed on those providers who do not comply with these arrangements providing they have been adequately resourced to do so.

Section 6 Do you consider there is a need for independent scrutiny of clinical and social care services?
The CPHVA welcome the proposal to establish an independent body to monitor clinical and social care standards. It is important that a wide range of health professionals, professional organisations and users be represented on this Authority to ensure an open and transparent process. How could user representation be secured – on the board of the Health and Social Services Authority and when carrying out reviews and investigations? User/s representatives should be appointed to this Authority adhering to a strict interviewing procedure of credible experienced candidates, rotating on a 2 yearly basis. Other user representatives could be co-opted on to the authority to advise on particular issues relating to their specific field of expertise as and when requi

Section 7 The CPHVA welcomes the proposal to extend and improve the regulation of a wider range of care services. The setting up of the Northern Ireland Commission for Care services as an independent non-departmental body should ensure that all establishments are treated equally and consistent standards of care are provided. The list of services outlined in the document for future regulation appears to be very comprehensive. The range of services proposed for future monitoring are very varied and as such it would be difficult to have the new body structured on a specialist basis. It would be more cost effective to have a generic basis with specialist oversight. The new Northern Ireland Commission for Care Services should make available a report of their inspections for public scrutiny so that the public and users can make informed choices when deciding to avail of a particular service. This would also encourage care establishments to maintain a high standard of care and accommodation Section 8. The proposals in this document do not appear to have any particular implication for equality issues as covered in section 75 of and Schedule 9 to the Northern Ireland Act 1998. However when the various bodies are set up to monitor and regulate standards of health and social care services it is important to ensure that they include voluntary, statutory and user representation. Briege Coyle Professional Officer Community Practitioners and Health Visitors Association