The Regulation and Improvement Authority (Independent Health Care) (Fees and Frequency of Inspections) (Amendment) Regulations (Northern Ireland) 2011

Made: 25th January 2011

Coming into operation: 1st April 2011

In accordance with Article 23 (8) of that Order, the Department has consulted such persons as it considers appropriate.

Citation and commencement

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These Regulations may be cited as the Regulation and Improvement Authority (Independent Health Care) (Fees and Frequency of Inspections) (Amendment) Regulations (Northern Ireland) 2011 and shall come into operation on 1st April 2011.

Amendment of the Independent Health Care Regulations (Northern Ireland) 2005

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• (1) The Independent Health Care Regulations (Northern Ireland) 2005[^f00002] shall be amended in accordance with paragraphs (2) to (13).

Amendment of regulation 22In regulation 2 (Interpretation), in paragraph (1)—aafter the definition of “health care professional” insert—“insurance provider” means—a person regulated by the Financial Services Authority who sells insurance, or underwrites the risk of such an insurance, orthe agent of such a person;bafter the definition of “patient’s guide” insert—“personal dental services” has the same meaning as in Article 3(7) of the Health Services (Primary Care) (Northern Ireland) Order 1997 [^f00003]; andcafter the definition of a “registered provider” insert—“RQIA” means the Health and Social Care Regulation and Quality Improvement Authority;.

Amendment of regulation 33In regulation 3 (Exceptions to the definition of independent hospital)-aat the end of paragraph (g), omit “and”, andbfor paragraph (h) substitute the following paragraphs—ha surgery or consulting room (which is not part of a hospital) in which a medical practitioner provides medical services only under arrangements made on behalf of the patients by —itheir employer;ii a Northern Ireland department;iiia prison or other establishment in which the patients are held in custody, other than pursuant to any provision of the Mental Health Order (Northern Ireland) 1986[^f00004]; orivan insurance provider with whom the patients hold an insurance policy, other than a insurance policy which is solely or primarily intended to provide benefits in connection with the diagnosis or treatment of physical or mental illness, disability or infirmity; andian establishment which has as its sole purpose the provision by a dental practitioner of general dental services [^f00005], or personal dental services [^f00006] and such an establishment shall not become an independent hospital as a result of the provision of listed services to a patient by such a dental practitioner

Amendment of regulation 44In regulation 4 (1) (Prescribed techniques or technology)—aat the end of sub-paragraph (c) delete “and”, andbafter sub-paragraph (d), there shall be added the following sub-paragraphs—ehaemodialysis or peritoneal dialysis; andfhyperbaric therapy, being the administration of oxygen (whether or not combined with one or more other gases) through a mask to a patient who is in a sealed chamber which is gradually pressurised with compressed air, where such therapy is carried out by or under the supervision or direction of a medical practitioner, except where the primary use of that chamber is—ipursuant to regulation 6(3)(b) of the Diving at Work Regulations (Northern Ireland) 2005[^f00007] or regulation 8 or 12 of the Work in Compressed Air Regulations (Northern Ireland) 2004[^f00008]; oriiotherwise for the treatment of workers in connection with the work which they perform.

Insertion of regulation 4A5After regulation 4 there shall be inserted the following regulation—Modification of Article 2(7) of the Order4AParagraph (7) of Article 2 of the Order shall be modified by substituting for sub-paragraph (b), the following sub-paragraph—bdental treatment;..

Amendment of regulation 56In regulation 5 (Meaning of independent clinic)—aIn paragraph (1), for sub-paragraph (b) substitute —bunless paragraph (1A) applies, a surgery or consulting room in which a medical practitioner who provides no services in pursuance of the 1972 Order provides medical services of any kind (including psychiatric treatment). andbafter paragraph (1), insert—1AParagraph (1)(b) does not apply to an establishment where medical services are provided only under arrangements made on behalf of the patients by—atheir employer;ba Northern Ireland department;ca prison or other establishment in which the patients are held in custody, other than pursuant to any provision of the Mental Health Order (Northern Ireland) 1986[^f00009]; ordan insurance provider with whom the patients hold an insurance policy, other than an insurance policy which is solely or primarily intended to provide benefits in connection with the diagnosis or treatment of physical or mental illness, disability or infirmity.

Amendment of regulation 67For regulation 6 (Exception of undertaking from the definition of independent medical agency, substitute—6For the purposes of the Order, any undertaking which consists of the provision of medical services by a medical practitioner only under arrangements made on behalf of the patients by—atheir employer;ba Northern Ireland department;ca prison or other establishment in which the patients are held in custody, other than pursuant to any provision of the Mental Health Order (Northern Ireland) 1986; ordan insurance company with whom the patients hold an insurance policy, other than an insurance policy which is solely or primarily intended to provide benefits in connection with the diagnosis or treatment of physical or mental illness, disability or infirmity,shall be excepted from being an independent medical agency.

Insertion of regulation 9A (Requirements for statement of policies and procedures)8There shall be inserted after Regulation 9 (Review of statement of purpose and patient’s guide) the following regulation—Requirements for statements of policies & procedures9A1The registered person shall implement written statements of the policies to be applied and the procedures to be followed in or for the purposes of an establishment in relation to—athe arrangements for admission or acceptance of patients, their transfer to a hospital where required and, in the case of an establishment which admits in-patients, their discharge;bthe arrangements for assessment, diagnosis and treatment of patients;censuring that the premises used by or for the purpose of an establishment are at all times fit for the purpose for which they are used;dmonitoring the quality and suitability of facilities and equipment;eidentifying, assessing and managing risks to employees, patients and visitors associated with the operation of the establishment;fthe creation, management, handling and storage of records and other information;gthe provision of information to patients and others;hthe recruitment, induction and retention of employees and their employment conditions;ithe grant and withdrawal of practising privileges to medical practitioners in establishments where such privileges are granted; andjensuring that, where research is carried out in an establishment, it is carried out with the consent of any patient or patients involved, is appropriate for the establishment concerned and is conducted in accordance with up-to-date and authoritative published guidance on the conduct of research projects.2The registered person shall prepare and implement a written statement of the policies to be applied and the procedures to be followed for the purposes of an agency in relation to—athe arrangements for transfer to a hospital, where required; andbeach of the matters specified in sub-paragraphs (b), (f), (g) and (h) of paragraph (1)3The registered person shall prepare and implement written statements of policies to be applied and procedures to be followed in or for the purposes of an establishment, or for the purpose of an agency, which ensure that—athe competence of each patient to consent to treatment is assessed;bin the case of a competent patient, properly informed consent to treatment is obtained;cin the case of a patient who is not competent, he is, so far as practicable, consulted before any treatment proposed for him is administered; anddinformation about a patient’s health and treatment is disclosed only to those persons who need to be aware of that information in order to treat the patient effectively or minimise any risk of the patient harming himself or another person, or for the purpose of the proper administration of the establishment or agency.4The registered person shall review the operation of each policy and procedure implemented under—athis regulationbregulation 23; andcin so far as they apply to him, regulations 35, 39C and 39Dat intervals of not more than three years and shall, where appropriate, prepare and implement revised policies and procedures.5The registered person shall make a copy of all written statements prepared in accordance with this regulation available for inspection by the RQIA.

Insertion of regulations 39A to 39E9There shall be inserted after Regulation 39 (Use of certain techniques or technology) the following regulations —”INDEPENDENT HOSPITALS THE MAIN PURPOSE OF WHICH IS TO PROVIDE MEDICAL OR PSYCHIATRIC TREATMENT FOR MENTAL DISORDER39ARegulations 39B to 39E apply to independent hospitals the main purpose of which, is to provide medical or psychiatric treatment for mental disorder.Safety of patients and others39B1In addition to the statement of policies and procedures to be prepared in accordance with regulation 9A, the registered person shall prepare and implement written statements addressing policies and procedures in relation to—aassessment of a patient’s propensity to violence and self harm;bthe provision of information to employees as to the outcome of such an assessment;cassessment of the effect of the layout of the hospital premises, and its policies and procedures, on the risk of a patient harming himself or another person; anddthe provision of training to enable employees to minimise risk of a patient harming himself or another person.2The registered person shall in particular prepare and implement a suicide protocol, which requires—aa comprehensive examination of the mental condition of each patient;ban evaluation of the patient’s history of mental disorder, including identification of suicidal tendencies;can assessment of the patient’s propensity to suicide;dif necessary, appropriate action to reduce the risk of the patient committing suicide.Management of disturbed behaviour39CThe registered person shall prepare and implement a written statement of policy setting out—ahow disturbed behaviour exhibited by a patient is to be managed;bpermitted measures of restraint and the circumstances in which they may be used;crequirements for employees to report serious incidents of violence or self harm, including guidance as to how those incidents should be classified; anddthe procedure for review of such incidents and determination of the action which is to be taken subsequently.Visitors39DThe registered person shall prepare and implement written policies and procedures in relation to patients receiving visitors.Mental health records39EThe registered person shall ensure that any records which are required to be made under the Mental Health (Nurses, Guardianship, Consent to Treatment and Prescribed Forms) Regulations (Northern Ireland) 1986[^f00010], and which relate to the treatment of a patient in an independent hospital, are kept for a period of not less than ten years beginning on the date on which the person to whom they relate ceases to be a patient in the hospital..

Amendment of regulation 42(Offences)10For paragraph (1) of regulation 42 (Offences), there shall be substituted the following paragraph—421A contravention of any of the provisions of regulations 7, 8, 9A, 14, 15, 16(1) to (4), 17 to 32 and 34 to 40 shall be an offence.11For paragraph 2 of Schedule 2 (Information required in respect of persons seeking to carry on, manage or work at an establishment or agency) there shall be substituted the following paragraph:2Either—awhere a certificate is required for a position that falls within Regulation 9 of the Police Act 1997 (Criminal Records) (Disclosure) Regulations (Northern Ireland) 2008 [^f00011], an enhanced criminal record certificate issued under section 113B [^f00012] of the Police Act 1997 which includes, as applicable, suitability information relating to adults (within the meaning of sections 113BB(2) of that Act) or suitability information relating to children (within the meaning of section 113BA(2) of that Act) or both; orbin any other case, a criminal record certificate issued under section 113A of the Police Act 1997..12In Schedule 3 (Period for which medical records must be retained), for Part I, there shall be substituted the following Part—PART 1PERIOD FOR WHICH MEDICAL RECORDS MUST BE RETAINEDType of PatientMinimum period of retention(a) Patient who was under the age of 17 years at the date on which the treatment to which the records refer was concluded.Until the patient’s 27th birthday.(b) Patient who was aged 17 years at the date on which the treatment to which the records refer was concluded.Until the patient’s 27th birthday.(c) Patient who died before attaining the age of 18 yearsA period of 10 years beginning on the date of the patient’s death.(d) Patient who was treated for mental disorder during the period to which the records referA period of 20 years beginning on the date of the last entry in the record(e) Patient who was treated for mental disorder during the period to which the records refer and who died whilst receiving their treatmentA period of 10 years beginning on the date of the patient’s death.(f) Patient whose records relate to treatment by a general practitioner.A period of 10 years beginning on the date of the last entry(g) All other cases.A period of 10 years beginning on the date of the last entry in the record.13In Part II of Schedule 3 (Records to be maintained for inspection), at the end of paragraph 1 insert —kWhere a patient has been received into guardianship under the Mental Health (Northern Ireland) Order 1986, the name, address and telephone number of the guardian..

Amendment of the Regulation and Improvement Authority (Fees and Frequency of Inspections) Regulations (Northern Ireland) 2005

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• (1) The Regulation and Improvement Authority (Fees and Frequency of Inspections) Regulations (Northern Ireland) 2005[^f00013] shall be amended in accordance with the following paragraphs —

• (2) In regulation 2 (1) (Interpretation)—

• (a) for the definition of “approved place” there shall be substituted the following definition—

• “approved place” means in relation to an establishment, a bed provided for the use of a service user at night or a dental practitioner’s chair used for the purposes of the provision of dental treatment;

• (b) for the definition of “small establishment” there shall be substituted the following definition—

• “small establishment” means an establishment, other than an independent hospital, which has less than four approved places.

Signed

Sealed with the Official Seal of the Department of Health, Social Services and Public Safety on 25 January 2011

Dr J F Livingstone — A senior officer of the — Department of Health, Social Services and Public Safety

Explanatory note

(This note is not part of the Order)

EXPLANATORY NOTE

These Regulations are made under the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 (the Order) and they amend the Independent Health Care Regulations (Northern Ireland) 2005 (“the principal regulations”) and the Regulation and Improvement Authority (Fees and Frequency of Inspections) Regulations (Northern Ireland) 2005.

Regulation 2 of these Regulations amends the principal regulations as follows:

1It extends the exceptions to the definition of independent hospital to include –isurgeries or consulting rooms where medical practitioners provide services only under certain arrangements made on behalf of patients by their employers or other specified bodies; andiiestablishments where dental treatment is delivered solely under HSC arrangements (regulation 2(3)).

2It includes in “listed services”, treatments such as haemodialysis and peritoneal dialysis and certain hyperbaric oxygen therapy delivered in sealed compressed air chambers (regulation 2 (4)).

3It inserts a new regulation 4A into the principal regulations to modify Article 2(7) (b) of the Order to read “dental treatment” with the effect (when account is taken of new regulation 3 (i) to exclude dentists delivering treatment solely within the HSC) of requiring regulation of dental treatment delivered privately (regulation 2(5)).

4It amends regulation 5 (Meaning of independent clinic) of the principal regulations so that an establishment where medical services are provided only under arrangements made on behalf of patients by their employers and other specified bodies is not to be regarded as an independent clinic (regulation 2(6)).

5It substitutes regulation 6 (Exception of undertaking from the definition of independent medical agency) of the principal regulations in order to except from the definition of independent medical agency an undertaking which provides medical services under arrangements made on behalf of patients by their employers and other specified bodies (regulation 2(7)).

6It inserts a new regulation 9A (Requirements for statements of policies and procedures) into the principal regulations to require certain written policies and procedures to be implemented in relation to arrangements for patients in independent hospitals (regulation 2(8)) and it also inserts regulations 39A to 39 E introducing requirements applying to independent hospitals providing mental or psychiatric treatment for mental disorder (regulation 2(9)).

7It substitutes Regulation 42(1) so that a contravention of regulation 9A is also an offence under the regulations (regulation 2(10)).

8It amends Schedules 2 & 3 to the principal regulations to update certain statutory references and to substitute the updated Part I table in Schedule 3, relating to records retention.

Regulation and Improvement Authority (Fees and Frequency of Inspection) Regulations (Northern Ireland) 2005An amendment is introduced to these regulations substituting a new definition of “approved place” to include dentist chairs in dental surgeries and to substitute a new definition of “small establishment” to exclude independent hospitals from the definition (regulation 3).

Footnotes

[^f00001]: S.I. 2003/431 (N.I.9)

[^f00002]: S.R 2005 No. 174

[^f00003]: S.I. 1997/1177 (N.I.7)

[^f00004]: S.I 1986/595 (N.I.4)

[^f00005]: See Article 2 of the Health and Personal Social Services (Northern Ireland) Order 1972

[^f00006]: See Article 3 (7) of the Health Services (Primary Care) (N.I.) Order 1997

[^f00007]: S.R. 2005 No.45

[^f00008]: S.R. 2004 No.241

[^f00009]: S.I. 1986/595 (N.I.4) as amended by S.I. 1994 No.429 (N.I.2) & S.I. 2004 No. 1272 (N.I.8)

[^f00010]: S.R. 1986 No. 174 as amended by S.R. 1998 No. 427

[^f00011]: S.I. 2008/542, the relevant amending instrument is S.I. 2009/2495

[^f00012]: 1997 (c.50). Sections 113A and 113B were inserted by section 163(2) of the Serious Organised Crime and Police Act 2005 (c.15) and amended by section 63(1) of, and paragraph 14 of Schedule 9 to the Safeguarding and Vulnerable Groups Act 2006 (c.47). Section 113BA was inserted by section 63(1) of, and paragraph 14 of Schedule 9 to the Safeguarding and Vulnerable Groups Act 2006.

[^f00013]: S.R. 2005 No. 182 as amended by S.R. 2006 No. 341; S.R. 2007 No. 223 and S.R.2010 No. 291

Editorial notes

[^key-3b33e2733ff4212bbf9422b7b46af7b3]: Reg. 1 in operation at 1.4.2011, see reg. 1

[^key-8c47e8805e5e12dce9bb7a4ec861f6fd]: Reg. 2 in operation at 1.4.2011, see reg. 1

[^key-0632c134639b21fe1621d988e4df6e0c]: Reg. 3 in operation at 1.4.2011, see reg. 1