Care homes: NI health chiefs were warned that halting RQIA inspections could attract media attention


By Tanya Fowles, Local Democracy Reporting Service

SENIOR Department of Health officials were warned of potential media attention if the Regulation and Quality Improvement Authority (RQIA) reduced inspections of care homes as preparations were under way for the Covid-19 surge.

While Health Trusts were made aware of the controversial move in a letter from Permanent Secretary Richard Pengelly, it was not specifically highlighted publicly.

The direction, issued by Chief Medical Officer Michael McBride, is contended to have contributed to the mass resignation of the entire RQIA board, who felt they were not being consulted on important decisions.

Documents obtained by BBC Local Democracy show inter-agency engagement within the Department of Health, ahead of the decision.

In a rapidly developing situation, a departmental director wrote to RQIA Chief Executive Olive MacLeod on March 13, referring to discussions around: “Whether unannounced inspections should be suspended.”

He continued: “Obviously, as per legislation we can direct, and we would need Ministerial coverage … I am minded to suspend unannounced inspections for a period of time.”

The same day, an email from Silver to Gold Command, requested consideration for RQIA to stop unannounced inspections completely: “Presumably to take some pressure off the sector while they gear up for the Covid-19 response.”

Following this, a submission to Minister for Health Robin Swann, the Chief Medical Officer and the Permanent Secretary sought approval to: “Issue direction to RQIA to proportionally manage/stand down its statutory and non-statutory inspection activity with immediate effect.”

Under the heading, ‘Presentational Issues’, the submissions states: “This reduction has the potential to attract media attention.”

Meanwhile, the first draft was emailed to Ms. MacLeod for consideration on the: “Departmental direction in relation to stat [sic] and non-statutory inspections.”

In response, she felt: “It would be more helpful if you stated that we pause all regulatory inspections except where we have concerns [of] risk or enforcement.”

The wording ultimately settled upon directing RQIA to: “Reduce the frequency” of statutory inspection activity and cease non-statutory with immediate effect, until otherwise directed.

This was approved on March 19, and quietly took effect when issued to RQIA the following day.

BBC Local Democracy asked the Department – as Gold Command – to clarify which agencies comprise Silver Command, given that was the origin of discussions to halt inspections.

A spokesperson replied: “Health and Social Care (HSC) Silver [Command] comprises representatives of Health and Social Care Board, Public Health Agency and BSO.

“HSC Silver Command collated input from Trusts, RQIA and NIBTS (Northern Ireland Blood Transfusion Service). This request could have come from one or more of the organisations.”

It is therefore unclear which agency triggered the discussion leading to the halting of inspections.

Shortly afterwards, Ms. MacLeod was made interim Chief Executive of the Public Health Agency.

This added to the concerns of the RQIA board, which was unsettled by the redeployment of senior staff at such a critical time.

In mid-April, news of the direction broke, and within a fortnight, inspections resumed with gradually increasing frequency.

However, it proved too much for the nine-strong board, who resigned on June 22 – the day before normal inspection activity was reached – claiming the Department failed to consult them on key issues.

It has since emerged that, during the six weeks the direction was in force, RQIA carried out only a handful of in-person inspections of buildings – none of which housed residents.

When contacted, the Department advised the Permanent Secretary’s letter to Trusts discussed the approach taken to RQIA inspections, and contended this was highlighted in a press statement.

However, on studying this, the only reference is in general terms, stating: “In some cases, it is recognised that this may mean that other services are temporarily reduced as the focus is on providing essential services and helping those most at risk access the best possible treatment.”

The RQIA is not referenced at all.