Health and Social Care Committee
The work of the Healthcare Inspectorate Wales
Evidence from Inspection Wales – HIW 11
The National Assembly for Wales’ Health and Social Care Committee inquiry into the work of Healthcare Inspectorate Wales (HIW)
Submission by Inspection Wales
1. The letter from David Rees AM, Chair of the National Assembly for Wales’ Health and Social Care Committee dated 23 July 2013, invited written evidence submissions from individuals and organisations to the Committee’s inquiry into the work of Healthcare Inspectorate Wales (HIW). Inspection Wales welcomes the opportunity to contribute, specifically to the area of the Inquiry’s terms of reference “The effectiveness of working relationships, focus on collaboration and information sharing between HIW, key stakeholders and other review bodies.” Inspection Wales does not anticipate giving oral evidence because the Committee is likely to receive oral evidence from individual Inspection Wales partner organisations.
2. The letter from David Rees AM requested that organisations should give a brief description of their role along with their submission. This is provided below.
Introduction
3. In 2011, the Heads of The Wales Audit Office (WAO), Care & Social Services Inspectorate Wales (CSSIW), Estyn and Healthcare Inspectorate Wales (HIW) made a strategic agreement to establish Inspection Wales in order to enhance and strengthen collaboration, communication and co-ordination between the four inspection, audit and regulation (IAR) bodies in Wales.
The effectiveness of working relationships between HIW and other review bodies
4. The Inspection Wales initiative shows HIW’s commitment to joint working. As a full partner in Inspection Wales, deserves its due share of the credit for the achievements to date. When they are able to attend, HIW staff participate fully in the range of Inspection Wales working groups and contribute actively to them. However, capacity issues and competing priorities have affected HIW attendance at working groups, Inspection Wales Programme Board and also the Heads of Inspectorates Group. This has affected the productivity of meetings or lead to meetings having to be rescheduled and in some cases cancelled, sometimes at short notice. Where substitutes have attended, this affects continuity of representation and can affect the quality of contribution. Capacity constraints have also affected the extent and pace of work done outside and between working group meetings, which can limit the progress possible. These problems impact upon the speed and timeliness with which tasks have been completed and therefore upon delivery of the Inspection Wales Programme.
5. Capacity issues and conflicting priorities are not unique to HIW. At times, all of the Inspection Wales partners have struggled to meet their commitments to the Inspection Wales Programme because operational staff, with demanding workloads, are involved in delivering it. However, attendance monitoring undertaken by the Inspection Wales Secretariat, which is reported to the Inspection Wales Programme Board, shows that HIW experience particular difficulties. Addressing capacity issues and reactive demand pressures within HIW would enhance the effectiveness of working relationships, collaboration and information sharing between HIW and other IAR bodies in Wales and would increase the positive impact of Inspection Wales.
Key Inspection Wales activities and achievements
6. Inspection Wales’s working groups have been engaged in activities aimed at making the best use of resources whilst continuing to deliver business effectively. These include:
· Identifying and piloting low cost information technology based solutions to meet non-personal information sharing operational requirements, securely and with minimal additional demands upon staff. The principal purpose of sharing information is to enable auditors and inspectors to make clear, informed and balanced judgements based on collective knowledge and information.
· Agreeing a shared Protocol for dealing with exceptional and serious concerns about any local authority that requires a joint response, outside existing planned programmes of work.
· Establishing an Inspection Wales website to help direct members of the public (who may not understand the roles and remits of the IARs) to appropriate information sources and also to support joint working by IAR staff.
· Developing joint induction material for new staff and also procuring and co-ordinating delivery of staff training in areas of common interest, such as equalities.
· Agreeing a work joint approach and tool that supports timely sharing of knowledge and expertise across IAR bodies to inform work plans and priorities for local government.
· In addition, a work planning approach for the health sector is being produced, building upon the existing Healthcare Protocol agreed between HIW and WAO and the healthcare summit arrangements, which will be equivalent to the local government approach above.
· Improving alignment of business planning cycles across IAR bodies, to facilitate timely exchange of information.
7. Experience to date has shown that an extraordinary inspection or investigation often requires the involvement of several IAR bodies, in order to make best use of intelligence and complementary inspection or audit methodologies. The Protocol agreed between Inspection Wales partners for this eventuality sets out a high-level, principles based framework within which decisions need to be made to suit the specific circumstances which give rise to concern. Where it is concluded that a joint extraordinary inspection or investigation is not justified as the subject falls within the remit of a single IAR body, normal information sharing and joint working arrangement apply. Specific examples of joint projects delivered in response to exceptional circumstances which Inspection Wales has contributed to are:
· Joint HIW and WAO report on Betsi Cadwaladr University Health Board(2013)
· Joint Inspection of Local Safeguarding Children’s Boards (2011)
· Joint Review of Youth Offending Services (2010)
8. Inspection Wales has produced other benefits in addition to the direct activities of the working groups and delivery of joint projects, including:
· Supporting Welsh Government requirements for timely information about issues arising from IAR activities and risks in relation to public bodies in Wales.
· Strengthening networking between Heads of Inspectorates and between the IAR bodies at senior management levels, as well as between staff involved in working groups and joint project delivery.
· Providing a forum for discussion between IARs of topics of common interest, for example, the Francis Report
9. Some inspection, audit, review and investigation work involves other regulators and inspectors not involved in the Inspection Wales Strategic Agreement, including UK bodies. This Inspection Wales initiative does not include them but recognises that there may be circumstances in which their involvement in a joint extraordinary inspection or investigation is appropriate. Inspection Wales provides an effective conduit for communication between the Inspection Wales partners and these other bodies.
The role and purpose of Inspection Wales
10. The current financial climate and policy context make it timely to enhance existing mechanisms for planning and delivering external review work in a co-ordinated and proportionate manner. The heads of the WAO), CSSIW, Estyn and HIW are fully committed to securing continuing improvement in collaborative working arrangements between inspection, audit and regulation (IAR) bodies in Wales.
11. For local government work this commitment reflects the statutory provisions of the Local Government (Wales) Measure 2009, which places a duty upon “relevant regulators” to share information and a co-ordination responsibility upon the Auditor General for Wales. For external review work within the NHS, the Concordat for Health & Social Care created a platform for joint delivery, and simplified NHS structures also assist by making it easier to plan work collaboratively and share intelligence.
12. The Strategic Agreement, reached in 2011 between CSSIW, Estyn, HIW and WAO, set out in the “Working Together in a Climate of Change” document gave a joint undertaking that information is shared to support the IAR’s commitment to partnership and collaboration in inspection, audit and regulation work.
13. In January 2012, the IAR bodies published “Good Practice Points From Joint Working Between The Inspectorates at Pembrokeshire County Council.” The document highlighted some weaknesses in information sharing between IARs and recommended improvements. The “Public Inquiry Report on Mid Staffordshire Hospital Foundation Trust” (the Francis Report), published in 2013, emphasised the need for improvements to arrangements for information sharing in England, some which are relevant to Wales.
14. Inspection Wales aims to build on the firm foundations of existing collaboration and take joint working arrangements to the next level in order to meet these challenges; recognisingthe extent of interdependence goals but also acknowledging areas of independence. The Inspection Wales initiative is unique amongst IAR bodies in the United Kingdom and is recognised by them as innovatory.
Inspection Wales Strategic Objectives
15. The Inspection Wales initiative reflects the Strategic Agreement between the Heads of WAO, CSSIW, Estyn and HIW to establish a partnership to improve information sharing and to strengthen co-ordination of work planning and delivery. Five strategic objectives agreed between the four IAR bodies are set out in “Working Together in a Climate of Change” :
Key Objective 1
Our joint and collaborative working is guided by a common vision and purpose, and supported where necessary by strategic agreements and operational protocols.
Key Objective 2
Our respective planning and programming activities will be co-ordinated such that they result in proportionate programmes of work which avoid duplication and ensure that key risks and concerns are being examined.
Key Objective 3
We will develop approaches to information and knowledge sharing between our respective organisations to guide our programmes of work and to help ensure that intelligence is actively and promptly shared.
Key Objective 4
We will identify opportunities to bring together the knowledge and intelligence we collectively hold on public services, and report this in ways which support service improvement, inform policy making and national scrutiny and strengthen public accountability.
Key Objective 5
We will continuously monitor the progress we are making with joint and collaborative working and report this openly and transparently to key stakeholders.
Exhibit 1: Inspection Wales’ role in strengthening arrangements between IAR bodies
The Inspection Wales Programme
16. The strategic objectives are delivered through the Inspection Wales Programme and its associated work streams set out in an Inspection Wales Programme Annual Plan. The Inspection Wales Programme evolves alongside the improvements and changes to the delivery of public sector inspection and review work currently being made by each body individually. The Inspection Wales Programme acts as a key enabler for change and innovation to achieve common aims and also adds value to what discrete IAR bodies are able to achieve; wherever the partners have a focus on common areas of delivery and accountability. This involves tackling some issues which in the past have proved challenging; including aligning business planning cycles to assist better joint programming and valuing the different perspectives and approaches to work within and across different sectors. The Inspection Wales initiative has led to the creation of tools and processes to support joint working and has also helped to foster positive working relationships among operational staff; vital to successful collaboration.
17. The Inspection Wales Programme consists of a number of projects, led and managed by the chairs of cross-inspectorate working groups established as vehicles to deliver objectives or parts of an objective. Working groups are chaired by individuals from one of the four organisations. Each working group has clear terms of reference and an action plan, agreed by the chair and the Inspection Wales Programme Board. Working Group members are responsible for keeping their own organisations abreast of progress within the group and for contributing fully to the group within the agreed timescales of the group’s action plan and within the scope of the group’s Terms of Reference.
18. The Inspection Wales Programme Board oversees the successful delivery of projects and is accountable to the Heads of Inspectorate Group (HOIG) for the delivery of the Inspection Wales Programme. The Inspection Wales Secretariat manages, enables, coordinates and supports the Projects, and when required, is the project lead. The secretariat consists of two members of staff seconded from the partner IARs:
Inspection Wales Programme Manager
The Inspection Wales Programme Manager is a member of the Programme Board, HOIG and working groups. It is a part-time position that reports directly to a director level representative from one of the four organisations. The Inspection Wales Programme Manager manages the overall delivery of the Inspection Wales Programme.
Inspection Wales Coordinator
The Inspection Wales Coordinator is a full time position that is responsible for supporting the Programme Manager and ensuring the effective administration, monitoring and day-to-day running of the Inspection Wales Programme. The Coordinator attends meetings and reports to the Programme Manager.