World of Irish Nursing & Midwifery May 2019


3.Government of Ireland.Slaintecare Implementation Strategy.Stationery Office,Dublin 2: Government of Ireland; 2018 4.Health Service Executive.Quality and Patient Safety, Clinical Governance Leaflet.Dublin 8: HSE; 2012 5.Department of Health. Improving Home Care Services in Ireland: Have Your Say! Dublin 2: DoH; 2017 6.HealthServiceExecutive.NationalGuidelines&Procedures fortheStandardised ImplementationoftheHomeSupport Service(HSSGuidelines)September2018KellsCoMeath Ireland.:HSE;2018[Availablefrom: eng/services/list/4/olderpeople/national-guidelines-and- procedures-for-the-standardised-implementation-of-the- home-support-service-hss-guidelines.pdf. 7.Cavendish C.The Cavendish review: an independent review into health care assistants and support workers in the NHS and social care settings.London: Department of Health.; 2013 8.Glackin P.The Evolving Role of the Health Care Assistant and its Implications for Regulation in the Republic of Ireland-A Case Study Approach.Northumbria University,UK.; 2016 9.Nursing andMidwifery Board of Ireland.Scope of Nursing Midwifery Practice Framework.Dublin:NMBI;2015 10.Health Service Executive.Health Service Employment Report: November 2018.Dublin 8: HSE; 2018 [Available from: our-workforce/health-service-employment-report- nov-2018-.pdf 11.Health Service Executive.National Service Plan 2019. Dublin 8: HSE; 2019 12.Health Service Executive.Home Help Service Roles & Responsibilities Dublin 8: HSE; 2014 [Available from: hse-clinical-governance-for-home-help-service-roles- and-responsibilities-august-2014.pdf 13.Warrick DD.The urgent need for skilled transformational leaders: Integrating transformational leadership and organization development.J Leadership, Accountability,and Ethics.2011;8(5):11-26

my opinion, true clinical governance of this service is not happening. When promoting the implementation of clinical governance to improve patient safety there is a need for clarity. Staff members need to know and understand their personal, team role and responsibili- ties at all times. The HSS delivery is under the control of the Social Care Division of the HSE and the PHNs work in the Primary Care Division. My impression is that PHNs have no defined authority in this process and there- fore cannot affect any meaningful change. This is an example of a confused unsafe picture that is a risk to patient safety. As an individual PHN on the ground, it is not clear what my roles and responsibil- ities in relation to the clinical governance of this service provision are. In my opinion the new HSS Guidelines (September 2018) necessitate the review and updating of Clinical Governance as set out in the HSE’s Home Help Service Roles and Responsibili-

responsibility for all care delivered via the HSS. This is regardless of whether the HCA works directly for the HSE or a private agency. This type of governance is inappro- priate and not fit for purpose as, how can you be responsible for clinical care deliv- ered by an external agency over whom you have no authority? Safety is an organisational issue and not just an individual practitioner one. The out- come of the 2014 HSE Home Help Service Roles and Responsibilities document will be to blame the person nearest the incident, 13 in this case the PHN, when poor standards of care delivery come to light. In my opinion the application of clinical governance to the HSS provision in Ireland is flawed and an imminent risk to patient safety. Rachel Eustace is a qualified public health nurse working in Malahide, Dublin North. She is currently undertaking a Masters in Leadership in the Royal College of Surgeons. References 1.World HealthOrganisation.Patient SafetyMaking health care safer.Geneva,Switzerland:WHO;2017 [Available from: patient-safety-making-health-care-safer/en/. 2.World Health Organisation.10 facts on patient safety Geneva,Switzerland.:WHO; 2018 [Available from: http://

ties document. 12 Imminent risk

The current clinical governance struc- ture states that PHNs retain clinical


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