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Features of a service meeting this standard are likely to include: 1.1.1 Proactive and systematic identification of service users’ collective needs and preferences. 1.1.2 Formal consideration is given to service users’ collective priorities, needs and preferences in the planning, design and delivery of services. 1.1.3 Involvement of service users at key stages in the planning and design of healthcare services. Service users are kept informed of key decisions during this process and how their needs and preferences have been considered. 1.1.4 Provision of services at a time and place which takes into account the expressed preferences of service users, where this provision can be achieved safely, effectively and efficiently. 1.1.5 Flexibility to respond to the changing needs and preferences of service users where this can be achieved safely, effectively and efficiently. 1.1.6 Coordination of care within and between services takes account of service users’ needs and preferences. 1.1.7 Feedback from service users being used to continuously improve the experience for all service users. 1.1.8 Regular evaluation of services to assess how well they are meeting the identified needs and preferences of service users.

 

This Standard refers to the planning, design and delivery of services which must be informed by patient’s needs and preferences.

1)   Healthcare Needs Assessment

HIQA guidance suggests that planning of services should be based on a population needs assessment.

The healthcare needs of a population will differ depending on the demographic profile, common health conditions and the social needs of the population. Information from population healthcare needs assessments and best available evidence facilitates the design, planning and delivery of services. This needs assessment approach also helps service providers in prioritising the delivery of services and where required, to change services for the benefit of service users.^[1]

Examples:

A healthcare needs assessment undertaken by a primary care team may highlight a proportion of patients with a specific long-term illness. This may result in the team developing a programme in partnership with patients to more effectively manage their condition. One aspect of such a programme may be to support and encourage self-management of that condition within the community.^[2]

A primary care practice undertaking a healthcare needs assessment may identify mental health or drug addiction issues in their population. As a result, further consultation may be undertaken with these groups to identify the health issues of most concern to them and how best to address these needs.

 

The HSE Guide to Needs Assessment in Primary Care can be accessed at the following link.http://www.hse.ie/eng/services/Publications/services/Hospitals/HSE_Publications/Stepping_Forward_-_Section_1.pdf

GMS Contractual requirements - You should note that under the GMS contract you are required to seek prior approval from the HSE before you change or open additional centres of practice. See the requirements for practice premises under the GMS contract 1989.

2)   Transfer of Care Between Services

When transferring patients between services you must pay attention to patient’s individual needs and preferences

• Ensure you have discussed and agreed the treatment or care plan with your patient. Ensure the patient has sufficient information to make an informed decision about their treatment or care.
• Inform the patient of the person who will be responsible for their care
• Use a standardised patient referral or discharge form

See Standards 1.4 and 1.5 for Informed Consent

HIQA standardised referral and discharge forms can be accessed at

http://www.hiqa.ie/publications/report-and-recommendations-patient-referrals-general-practice-outpatient-and-radiology-

http://www.hiqa.ie/publications/national-standard-patient-discharge-summary-information

HIQA and ICGP Standard Referral Form

 

3)   Regular Evaluation of Services - Reviewing Your Services and Seeking Patient Feedback

 

As a service provider you should be regularly reviewing your services in order to make your Practice more responsive to your patients’ needs.  You should actively be seeking and acting on feedback from your patients through:

• A suggestions/complaints/complements box
• Patient Satisfaction Surveys

It is not sufficient to simply seek feedback from your clients. You must be able to show that you have taken action in relation to the design and delivery of your services as a result of the feedback you have received. Ensure you keep a record of any action that you have taken.

See Standard 1.8 for Complaints Procedure

Useful links if you are considering carrying out a Patient Satisfaction survey:

HSE Staff Guide Using patient feedback to improve healthcare services

Northern Ireland General Practice Patient Survey

ISQSH - Measurement of Patient Satisfaction Guidelines

[2] HIQA, General Guidance on the National Standards for Safer Better Healthcare, Safer Better Care, September 2012, p. 12

[1] HIQA, General Guidance on the National Standards for Safer Better Healthcare, Safer Better Care, September 2012, p. 11

Features of a service meeting this standard are likely to include: 1.2.1 Promotion of equitable access, through service design based on relevant information about the people using services, to ensure available resources are deployed fairly.   1.2.2 Access for service users that is based on needs assessment and best available evidence, and is in line with relevant eligibility criteria. This is irrespective of factors such as the service users’ age, gender or geographical location.   1.2.3 Clear and transparent decision-making processes, including referral pathways, to facilitate service users’ access to healthcare services. The effectiveness of these processes is regularly evaluated.   1.2.4 Provision of clear and relevant information in usable formats for service users about the services available to them and how to access these services.   1.2.5 Identification of the access needs of the population served, including their physical, sensory and language needs, and arrangements to meet these needs in line with relevant legislation.

 

This standard requires you to ensure that your services are accessible to all patients in your community by:

 

• Complying with legislative requirements regarding accessibility for wheelchair users
• Providing assistive technology to facilitate patients with physical or sensory disability
• Establishing clear signs and directions your services
• Providing information in different formats to suit community

 

 

In relation to wheelchair accessibility the HIQA standards are broad stating that arrangements must be made in line with relevant legislation:

Broadly the legislation regarding accessibility is as follows:

• Building Regulations (Part M Amendment) 2010 require that, new buildings constructed after 1^st January 2001, and material changes to existing buildings constructed after 1^stJune 1992, are wheelchair accessible.

The Disability Act 2005 places an obligation on public bodies to make their buildings, services and information accessible to people with disabilities and 

 

• requires the preparation of Sectoral Plans to support continued improvements in six key areas of public service provision.
• Under the Equality Status Acts 2000 - 2004 providers of goods and services are required to accommodate the needs of people with disabilities through making reasonable changes in what they do and how they do it where, without these changes, it would be very difficult or impossible for people with disabilities to obtain those goods or services -unless this special treatment or special facilities cost more than a nominal cost. (The meaning of nominal cost will depend on the circumstances of each case such as the resources of the service provider).

 

Useful links for ensuring accessibility of your services.

The National Disability Authority (NDA) have a comprehensive publication entitled “Building for Everyone” which demonstrates how to design an accessible bathroom, install a ramp, widen doors etc. 

The Irish Wheelchair Association have developed Best Practice Access Guidelines: Designing Accessible Environments, 2010. 

The NDA have also developed a Access Handbook Template - A Tool to Help Manage the Accessibility of the Built Environment

This access handbook has been designed as an internal document for the use of management, maintenance personnel and new staff; and which all staff should be aware of. The purpose of the access handbook is to provide a simple way of listing and explaining the features and facilities of a building, which must be maintained and/or improved in order to ensure access for everyone…

The access handbook highlights:

·         Background information on access;

·         How to get to the [insert building name] building using various modes of transport;

·         Areas that need to be kept clear to ensure maximum accessibility;

·         Guidelines for accessible signage;

·         Management responsibilities;

·         How to Carry out a Maintenance Audit;

·         Means of escape.

Features of a service meeting this standard are likely to include: 1.3.1 Facilitation of service users to exercise civil, political and religious rights as enshrined in Irish law, as far as is reasonably practicable, when they are receiving healthcare. 1.3.2 Initial and ongoing access to healthcare for service users which is in compliance with legislation and does not discriminate according to age, gender, sexual orientation, disability, marital status, family status, race, religious belief, or membership of the Traveller Community.

This standard requires that all patients are treated equally and no patients are discriminated against on the grounds of age, gender, sexual orientation, disability, marital status, family status, race, religious belief, or membership of the Traveller Community.

The Equal Status Acts 2000–2008:

•        promote equality;

•        prohibit certain kinds of discrimination across nine grounds; age, gender, sexual orientation, disability, marital status, family status, race, religious belief, or membership of the Traveller Community;

•        prohibit sexual harassment and harassment;

•        prohibit victimisation;

·         require reasonable accommodation of people with disabilities;

•        allow a broad range of positive action measures.

The Acts apply to people who:

• buy and sell a wide variety of goods;

• use or provide a wide range of services;

• obtain or dispose of accommodation;

• attend at, or are in charge of, educational establishments.

 

Staff should receive training in Equality and Diversity. Keep a spreadsheet of staff who have received training.

 

Useful links:

 

The Equality Authority have produced a pamphlet for health service organisations which provides information on the provisions of the Equality Status Acts 2000 to 2004 and sets out the characteristics and practices of equality competent health service organisations.

 

National Disability Authority (NDA) Guidelines for Purchasers of Disability Equality Training - Embedding disability equality into the ethos of your organisation

 

 

Features of a service meeting this standard are likely to include: 1.4.1 Provision of accessible, clear, timely and relevant information to service users about their condition, treatment options and the services available to them. 1.4.2 Active facilitation of individual service users as much as possible to exercise choice in the ongoing planning and delivery of their care and treatment. 1.4.3 Facilitation of service users to access patient support services including, where appropriate, independent support groups. 1.4.4 Notification in advance to service users of any direct financial costs to them for services they may receive.

 Seeking Informed Consent

Standard 1.4 is about ensuring that patients have the necessary information to make an informed decision about their care. The amount of information required will depend on the nature of the condition, the complexity and risks associated with the investigative or treatment procedure. The Medical Council 2009 Guide to Professional Conduct and Ethics for Registered Medical Practitioners Appendix A lists the information that should be provided to patients prior to giving consent including: 

·         details of the diagnosis, and prognosis, and the likely prognosis if the condition is left untreated;

·         uncertainties about the diagnosis, including options for further investigation prior to treatment;

·         options for treatment or management of the condition, including the option not to treat;

·         the purpose of a proposed investigation or treatment;

·         details of the procedures or therapies involved, including methods of pain relief;

·         preparation for the procedure; and what the patient might experience during or after the procedure, including common and serious side effects;

·         for each option, explanations of the likely benefits and the probabilities of success; discussion of any serious or frequently occurring risks, and of any lifestyle changes which may be caused by, or necessitated by, the treatment;

·         advice about whether a proposed treatment is experimental;

·         how and when the patient’s condition and any side effects will be monitored or re-assessed;

·         the name of the doctor who will have overall responsibility for the treatment and, where appropriate, names of the senior members of his or her team;

·         whether doctors in training will be involved, and the extent to which students may be involved in an investigation or treatment;

·         a reminder that patients can change their minds about a decision at any time;

 

·         a reminder that patients have a right to seek a second opinion;

·         where applicable, details of costs or charges which the patient may have to meet.

 

 See Medical Council 2009 Guide to Professional Conduct and Ethics for Registered Medical Practitioners

 And Medical Council Good Practice in Seeking Informed Consent to Treatment

Also see HSE National Consent Policy which includes a comprehensive guide on obtaining valid consent and providing Information and discussing treatment options

 

Ensure that your patient records contain the options and risks that have been explained to the patient, a copy of any leaflets given, information about patient support groups and information about price. To ensure that patients have properly understood you may need to provide leaflets in different languages or provide the option of a translator.

 

Displaying a Price List and other General Information that should be provided in your Practice

A pricelist for routine procedures should be publicly displayed in your reception and waiting room. You should also include a pricelist in your Practice Leaflet or on your Practice website. 

See IMO Guide to developing a Practice Leaflet

ICGP guide to developing a practice website.

 

 

Information should also be available about common conditions (e.g., in the form of leaflets, booklets, service user discussions, information evenings). These leaflets should be available in different languages where possible. Information about patient support services and advocacy groups are also recommended. 

Features of a service meeting this standard are likely to include: 1.5.1 Arrangements to obtain, and act in accordance with, the informed consent of service users in line with legislation and best available evidence. 1.5.2 Effective arrangements that protect the best interests of children and service users who lack capacity to give informed consent. 1.5.3 Monitoring and evaluation of the effectiveness of the arrangements for obtaining informed consent and taking steps to address any identified areas for improvement.

 

In this Standard HIQA is looking to see whether the provider has suitable arrangements and systems in place for obtaining patient consent to care and treatment in line with legislation and best practice. It is recommended that the following are complied with:

 

1.     Procedures or guidelines in place for obtaining informed consent and available to all staff;

2.     All staff should be receive training in the consent process and a record should be kept;

3.     Patient consent forms should be used for complex procedures;

4.     Ensure that your patient records contain the options and risks that have been explained to the patient, as well as any decision aids and leaflets given to patients;

5.     Carry out of an audit of the consent process.

 

 

The HSE’s National Consent Policy provides a comprehensive guide to obtaining patient consent including:

 

·         Consent in Irish Law

·         Obtaining valid consent

·         Providing Information and discussing treatment options

·         Ensuring consent is voluntary

·         Capacity

·         Emergency situations

·         Refusal of treatment

·         Consent in Children and Minors

·         Consent for Research

·         Do Not Attempt Resuscitation (DNAR) Orders

 

Ensure that you are kept up to date with any changes in legislation.

 

Link to HSE National Consent Policy

 

Other Useful Links

Medical Council 2009 Guide to Professional Conduct and Ethics for Registered Medical Practitioners

Medical Council Good Practice in Seeking Informed Consent to Treatment

Medisec advice on consent to medical treatment

Consent to Medical Treatment in Ireland - An MPS Guide for Clinicians

 

 

Features of a service meeting this standard are likely to include: 1.6.1 Design and delivery of care in a manner which promotes service users’ dignity, privacy and autonomy. 1.6.2 Promotion and protection of service users’ privacy, dignity and autonomy within an appropriately designed and managed physical environment. 1.6.3 Communication with service users in a manner that respects their dignity and privacy. 1.6.4 Respect at all times for service users’ dignity and privacy when they are receiving personal care or attending to their own personal care. 1.6.5 Protection of a service user’s personal information at all times in line with legislation and best available evidence.

This standard requires that patients’ dignity and privacy is respected in the design and delivery of care.

Ensure that the physical environment respects patients’ dignity and privacy. Reception, waiting rooms, toilets, consultation rooms, should be well indicated. Ensure consultation rooms are sufficiently private. Use screens or curtains for intimate examinations or procedures.

1.     Chaperone policy

Draw up a chaperone policy for the practice. Keep a log of evidence that staff have read the policy – this could be in the form of a spreadsheet. Ensure that non clinical staff who act as chaperones are trained. Keep evidence of training.

The MPS Factsheet on using Chaperones

2.     Guidance on Doctor-Patient Confidentiality

• Take care with patient data: do not allow correspondence, notes or records to be accessed by others unnecessarily
• Provide confidentiality training for all staff and keep a record of this training. Ensure that all staff have signed a confidentiality statement that includes post-employment and covers the use of social networking sites.
• When using ICT, familiarise yourself with requirements under Data Protection Legislation
• If you use email to communicate with patients, ensure that safeguards are in place to preserve patient confidentiality. Unless messages are encrypted, patients should be aware that their messages could potentially be read by someone else. Any emails that are sent should be saved in the patient record.
• Ask yourself whether disclosure is really necessary
• Refer to the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners
• Always try to obtain consent to share patient data
• If legally or ethically obliged to breach confidence, it should be done only to the extent necessary and only to the relevant party or authority
• When disclosing information to national registers, for audit or research anonymise or de-identify the patient where possible otherwise seek permission from the patient
• If in doubt seek legal advice.

 

Useful links

IMO Role of the Doctor Series: Doctor-Patient Confidentiality

IMO Position Paper on Social Media:

MPS Medical Records in Ireland provides useful guidance on the keeping and managing medical records including environmental and security risks

When using information and communication technology, ensure that you comply with the requirements under data protection legislation

Medisec Advice on General Practitioners and Confidentiality

Medisec Advice on texting, faxing and emailing patients

 

1.     Staff code of conduct

 

It is necessary to have a staff Code of Conduct in place which includes respect for dignity and privacy. It is essential to ensure that all staff had read this policy and are fully aware of how they should conduct themselves.

 

 

HSE’s Policy for Health Service Employers on Upholding the Dignity and Welfare of Patient

 

Features of a service meeting this standard are likely to include: 1.8.1 Complaints procedures that are clear, transparent, open and accessible to service users and take account of legislation, relevant regulations, national guidelines and best available evidence. 1.8.2 Complaints procedures that ensure as timely a response as possible, taking account of the requirement to fully address the issues raised by the complainant. 1.8.3 Complaints procedures that identify the expectations of service users making complaints and ensure that these expectations are taken into account and addressed throughout the process. 1.8.4 A coordinated response to service users who make a complaint, including when their care is shared between healthcare professionals or transferred from one service provider to another. 1.8.5 A supportive environment for service users that encourages them to provide feedback, raise concerns or make complaints verbally or in writing in a culture of openness and partnership. 1.8.6 Support for a culture in which service users’ care is not negatively affected as a result of them having made a complaint or expressed a concern. 1.8.7 Structured arrangements to ensure that service users who make a complaint are facilitated to access support services, such as independent advocacy services.

 

1.     Complaints procedure

A Complaints procedure should be put in place where people who use services or others acting on their behalf are sure that their comments and complaints are listened to and acted on effectively.

Ensure you have written information for patients about how to make a complaint. A patient should be informed of the complaints procedure via leaflets, website information and posters. Staff should be encouraged to report verbal complaints. Appoint a “complaints manager” and “responsible person” within the practice. The responsible person should be the partner in the practice. A common arrangement is for the practice manager to act as complaints manager and a GP partner to take on responsibility as the responsible person. Learn and share issues highlighted from complaints, e.g., during team meetings.

• Ensure you have written information for patients about how to make a complaint.

A patient should be informed of the complaints procedure via leaflets, website information and posters. Staff should be encouraged to report verbal complaints.

• Appoint a “complaints manager” and “responsible person” within the practice. The responsible person should be the partner in the practice. A common arrangement is for the practice manager to act as complaints manager and a GP partner to take on responsibility as the responsible person.
• The complaints policy must be available to staff, e.g., on the practice intranet.

• There should be a time limit in place to ensure the timely outcome of complaints
• Comment cards and a suitable collection box can be placed in the waiting room.
• If a private patient is unhappy with the response to the complaint at first instance they have recourse to the medical council.
• If a public patient is unhappy with the response to the complaint they may contact the HSE Complains officer, if they are not satisfied with the response from the HSE they have recourse to the Ombudsman or Ombudsman for Children and the Medical Council.
• A patient should also be informed of the option to use a patient advocacy group should they so wish. The following are a list of patient advocacy groups:

-          http://www.patientadvocate.ie/

-          http://irishpatients.ie/news/

-          http://www.patientfocus.ie/site/index.php

 

Link to HSE Complaints Procedure “Your Service Your Say”: Link

 

Features of a service meeting this standard are likely to include: 1.8.1 Complaints procedures that are clear, transparent, open and accessible to service users and take account of legislation, relevant regulations, national guidelines and best available evidence. 1.8.2 Complaints procedures that ensure as timely a response as possible, taking account of the requirement to fully address the issues raised by the complainant. 1.8.3 Complaints procedures that identify the expectations of service users making complaints and ensure that these expectations are taken into account and addressed throughout the process. 1.8.4 A coordinated response to service users who make a complaint, including when their care is shared between healthcare professionals or transferred from one service provider to another. 1.8.5 A supportive environment for service users that encourages them to provide feedback, raise concerns or make complaints verbally or in writing in a culture of openness and partnership. 1.8.6 Support for a culture in which service users’ care is not negatively affected as a result of them having made a complaint or expressed a concern. 1.8.7 Structured arrangements to ensure that service users who make a complaint are facilitated to access support services, such as independent advocacy services.

 

1.     Complaints procedure

A Complaints procedure should be put in place where people who use services or others acting on their behalf are sure that their comments and complaints are listened to and acted on effectively.

Ensure you have written information for patients about how to make a complaint. A patient should be informed of the complaints procedure via leaflets, website information and posters. Staff should be encouraged to report verbal complaints. Appoint a “complaints manager” and “responsible person” within the practice. The responsible person should be the partner in the practice. A common arrangement is for the practice manager to act as complaints manager and a GP partner to take on responsibility as the responsible person. Learn and share issues highlighted from complaints, e.g., during team meetings.

• Ensure you have written information for patients about how to make a complaint.

A patient should be informed of the complaints procedure via leaflets, website information and posters. Staff should be encouraged to report verbal complaints.

• Appoint a “complaints manager” and “responsible person” within the practice. The responsible person should be the partner in the practice. A common arrangement is for the practice manager to act as complaints manager and a GP partner to take on responsibility as the responsible person.
• The complaints policy must be available to staff, e.g., on the practice intranet.

• There should be a time limit in place to ensure the timely outcome of complaints
• Comment cards and a suitable collection box can be placed in the waiting room.
• If a private patient is unhappy with the response to the complaint at first instance they have recourse to the medical council.
• If a public patient is unhappy with the response to the complaint they may contact the HSE Complains officer, if they are not satisfied with the response from the HSE they have recourse to the Ombudsman or Ombudsman for Children and the Medical Council.
• A patient should also be informed of the option to use a patient advocacy group should they so wish. The following are a list of patient advocacy groups:

-          http://www.patientadvocate.ie/

-          http://irishpatients.ie/news/

-          http://www.patientfocus.ie/site/index.php

 

Link to HSE Complaints Procedure “Your Service Your Say”: Link