Northern Ireland

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Regulation of healthcare quality in Northern Ireland

The quality of healthcare services in Northern Ireland is regulated principally by the RQIA (Regulation and Quality Improvement Authority), the independent health and social care regulator.

The HSCB (Health and Social Care Board) are responsible for the monitoring and appraisal of HSC (Health and Social Care) GP services.

The quality standards for health and social care are used by the RQIA in its inspections and as a guide for health and social care providers to improve services.

Quality regulation in Northern Ireland is also linked to Quality 2020, the 10 year quality improvement strategy launched by the Department of Health in 2011.






Enforcement powers

  • HSC (NHS) trusts and hospitals
  • GP practices
  • mental health services
  • social care
  • indepenent providers
Inspects and reviews all regulated services Do not give ratings
  • improvement notices
  • suspension/
    cancellation of registration
  • prosecution
  • special measures*
    *if authorised by Department of Health
  • GP practices
Inspects GP practices in a rolling programme Do not give ratings
  • suspension of practitioner registration


RQIA (Regulation and Quality Improvement Authority)

The RQIA was established in 2005 and is responsible for registering, monitoring and inspecting health and social care services in Northern Ireland, while encouraging improvement in their quality.

The three main areas of work for the RQIA are:

  • the registration and inspection of statutory and independent health and social care services
  • assuring the quality of services provided by HSC Trusts, the HSCB and other agencies
  • protecting the interests of individuals with learning disabilities and those with mental health conditions.



The RQIA inspects a wide array of services, including:

  • HSC (NHS) trusts and hospitals
  • independent healthcare providers
  • dental services
  • mental health and learning disability services
  • prisons
  • care homes
  • children’s homes
  • radiology services – enforcement of Ionising Radiation (Medical Exposure) Regulations (Northern Ireland) 2000.

The RQIA is not responsible for the inspection of GP practices.

RQIA inspectors can visit providers at any time, request information, conduct private interviews and examine premises. When they do inspect and review services, the RQIA focus on four key outcomes, whether care is safe, effective, and compassionate, and if services are well-led. Inspectors also utilise the quality standards for health and social care in order to assess the quality of services.

In its inspection reports the RQIA does not give ratings but will, where appropriate, provide:

  • recommendations for improvement where standards are not being met, with progress to be reviewed at later inspections
  • housekeeping points to assist providers to make rapid improvements to more minor problems
  • recognition of examples of good practice in cases where providers have exceeded expectations and illustrated methods that could be implemented by others. The findings of RQIA investigations are published on its website, and made available to the public.



If providers fail to meet the required standards, the RQIA can take a range of enforcement action, including issuing improvement notices, cancellation or alteration of registration, and prosecution.

The RQIA also has the authority to recommend to the Department of Health that special measures are taken in respect of the performance of a HSC Trust


HSCB (Health and Social Care Board)

The HSCB is the statutory body responsible for commissioning health and social care services in Northern Ireland, within this role it is also responsible for the inspection and appraisal of HSC GP practices.

In 2015 the then health minister, Simon Hamilton, announced that the HSCB would be closing, however, it currently continues to operate.



HSCB medical advisers operate a rolling programme of visits to GP practices across Northern Ireland, with each practice visited at least once every three years.

During visits, medical advisers assess and discuss the management of a practice, as well as clinical records, waiting times, training and overall performance.


Quality standards for health and social care

The quality standards for health and social care were launched by the Northern Ireland Executive in 2006 and serve as a general set of measures by which providers should assess and improve their services.12 The standards are open to interpretation by the RQIA, which uses them in its inspections, and fall under five broad themes:

  • corporate leadership and accountability of organisations
  • safe and effective care
  • accessible, flexible and responsive services
  • promoting, protecting and improving health and social wellbeing
  • effective communication and information.

The standards are also intended to help patients understand the quality of service they are entitled to.


Quality 2020

Quality 2020 was announced by the Department of Health in 2011 as a 10 year strategy to improve the quality of healthcare in Northern Ireland.

The strategy defines quality under three themes: safety, effectiveness and patient and client focus. It serves as a general framework for health and social care services and the RQIA to follow.


Reform and changes

Following recommendations made in the 2014 Donaldson Review, the RQIA now conducts unannounced inspections of all acute hospitals in Northern Ireland, specifically focusing on triage, assessment, care, monitoring and discharge.13 The RQIA began its hospital inspection programme in 2015.

Further changes may also occur. In October 2016 the health minister, Michelle O’Neill committed to the introduction of an Improvement Institute in Health and Wellbeing 2026, the paper announcing her vision for healthcare in Northern Ireland.14 This was published alongside Systems not Structures, the report into healthcare in Northern Ireland by the expert panel led by Professor Rafael Bengoa.


Full brief for Northern Ireland