Arrangements for Ensuring the Quality of Care in Homes for Older People

Mr Kieran Donnelly, Comptroller and Auditor General, today issued his report to the Assembly on “Arrangements for Ensuring the Quality of Care in Homes for Older People”. In Northern Ireland, the Department of Health, Social Services and Public Safety (the Department) is responsible for promoting the health and wellbeing of the people of Northern Ireland. As part of its responsibilities, the Department is committed to ensuring services are safe and sustainable, accessible and patient-centred.


At March 2009, around 9,500 older people had been placed by Health and Social Care Trusts (the Trusts) in 490 registered residential care and nursing homes. Care within these homes costs over £280 million each year.

Responsibility for ensuring that the quality of care within these homes is in line with regulations and standards falls to commissioners, providers and regulators of care.

All residential care and nursing homes for older people must register with the Regulation and Quality Improvement Authority (RQIA). They must comply with relevant statutory regulations, and are expected to comply with a list of minimum standards developed by the Department.

Since those who live in nursing and residential homes are some of the most vulnerable in our society, it is important to have effective arrangements in place for assuring the quality of care they receive. RQIA is responsible for keeping the Department informed about the quality and availability of care and for encouraging improvement.

Main Findings:

The report identifies the following:

  • Currently, social care workers and nursing support staff are not required to be registered or qualified, although many do so voluntarily. Formal registration and qualification of the workforce would be a significant step in enhancing their status and improving the quality of care provided in residential care and nursing homes. The Department is currently considering the way forward, and must set a clear timetable for improving the regulation of care staff;
  • All registered care homes are subject to a minimum of two inspections a year by RQIA, one announced and one unannounced. We welcome RQIA’s intention to extend the focus of these inspections beyond compliance with standards and place more emphasis on assessing quality in terms of service user experiences and outcomes;
  • Data from RQIA shows that over the three year period 2006-07 to 2008-09, 45 “failure to comply” notices and accompanying quality improvement plans (see Notes) and 10 notices “imposing additional conditions of registration” (see Notes) were issued to 29 of the 490 registered homes. In 2008, a home in Antrim was issued with three separate “failure to comply” notices. Following the home’s inability to sustain improvement, the owners closed this home voluntarily.
  • RQIA collects a significant amount of information about homes during the inspection process. RQIA should bring together information from all available sources to give an overall view of quality of care across all care homes, facilitate the sharing of good practice and inform commissioning decisions.
  • The regulatory bodies in England, Scotland, Wales and the Republic of Ireland publish their inspection reports on-line. In addition, England and Scotland provide information to facilitate comparisons across providers. We welcome RQIA’s recent publication of its inspection reports on-line. It should also take steps to provide comparative information to inform service users (and potential service-users) of the quality of care available.
  • Procedures for dealing with, and reporting on, complaints and quality issues in independent sector homes vary across the Trusts. One Trust has established a dedicated team to deal with all such issues, which ensures that they are given the same prominence as the Trust’s own complaints. This should be the goal for all Trusts.
  • Management information about complaints and quality issues in residential care and nursing homes is not collected together in a comprehensive way. This means that it is more difficult for Trusts, the HSC Board and RQIA to deal with quality issues in a planned and proactive way. Many complaints may appear minor but can cause stress, have an adverse impact on quality of life and be early indicators of bad practice or potential abuse. Trusts, HSC Board and RQIA must liaise to ensure that information about quality issues raised through complaints in regulated homes is shared between the relevant agencies and analysed as part of a comprehensive overview of complaints management in health and social care.

Notes for Editors

  1. Registered home owners must comply with the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 and relevant regulations. Failure to comply is an offence. The home owner will be made aware of the intention to issue a Failure to Comply notice and the reason for it. The notice will set out the action that needs to be taken and the timescale, not exceeding 3 months, in which it should be taken. If the action is not taken, RQIA may take legal proceedings and will issue the registered provider with a notice of decision.
  2. Non-compliance with an Improvement Notice could result in the imposition of an additional condition of registration - ranging from restriction of admission, to cancellation of the registration of the registered person or full cancellation of the home’s registration - or a failure to comply notice.
  3. RQIA’s inspection reports are available at