Hospital policies

hippy18

Hi I'm hoping for a little bit of guidance if possible.

A few years ago my sister suffered a very severe brain injury and was an impatient for 9 months in a acute medical hospital. During this time my family felt my sister was treated very poorly by the hospital and to cut a very long story short my family took a complaint out with the ombudsman. I receive the final report on Monday where the hospital basically says they failed my sister and didn't treat her with proper care.

Obviously there is so much more to this story then I want to speak about here but one of the points in my family complaint was the fact no acute hospital in Ireland have any policies regarding restraints. I work in the care services and am very much aware of the restraints policy so to discover acute medical hospitals don't need to follow one I was kinda shocked.

Out of the 4 areas the ombudsman looked at in our complaint this was the only one not resolved in over 6 years and probably the one I personally wished they could have put into place because after watching how my sister was treated without any guidance was pretty appalling. As much as I understand an acute medical hospital is very different settings then a nursing/care home I still feel safeguarding towards people in acute medical sittings are just as important as people in care homes and some kinda regulations/guidance from the HSE is needed.

We had an amazing case worker in the ombudsman who spent a lot of time many years working with this acute hospital trying to fix some of the errors in the hospital and my family is so grateful but not having sorted the restraints policy I can't help but feel the system has failed my sister. The way my sister was treated and the forms of restraints used on my sister were very barbaric and how nightmares are made. I believe the ombudsman have done everything in their power to try implement a restraints policy into the acute hospital my sister was in but they can not enforce anything only the HSE can do that.

I am just wondering if anyone can advise me on how someone like me a complete no body ensures that the HSE does actually implement restraints policies into acute medical settings? I know deep down anyone who heard my sister's story would agree 100% that can not happen to another human being in this day and age but it does and most likely will continue until someone puts down on paper what is and isn't allowed regarding restraints in hospitals so I am looking at what to do next to ensure more safeguarding around people especially with reactive behaviour in acute medical hospitals.

Many thanks.

TooTired123

I don’t have anything to contribute apart from my sympathies to you and your family on the suffering and frustration you have suffered at the hands of the HSE.

hippy18

Thank you tootired123 my sister did suffer because of what the HSE allows in hospitals, she was treated so poorly without any dignity or respect shown. I hoped something would be put into place some kinda guidance would be put into place after we exposed how the hospital treated my sister and even tho the hospital have admitted they were in the wrong the lack of a policy regarding restraints is upsetting and scary for anyone who walks into the acute medical setting with any kinda brain injury because the hospital can use brute force to restrain patients who don't act accordingly due to their injury, even when the patient isn't a threat to anybody. I do hope someone can direct me, I don't wanna feel like I've let my sister down I promised her this would never happen to her again as it stands this could happen to her again, I know a policy is only a piece of paper but that piece of paper is the difference between a patient like my sister getting treated like she is a thug or someone with an brain injury, hospitals like care homes should have to follow a list of procedures before they can use restraints on people which should include physical restraints being the last option not the first.

Del2005

You need to get onto social media highlighting that the HSE doesn't have guidelines for restraints will other care providers do. You need to contact TDs and Senators. Contact local and national media. Basically and unfortunately you need to hassle and shame them into making the change. It's a shame that you need to do it that way.

3DataModem

"We had an amazing case worker in the ombudsman who spent a lot of time many years working with this acute hospital trying to fix some of the errors in the hospital"

• Nothing to add, other than I'm grateful for you and your family working to make other people's situation better.

rock22

Did the Ombudsman make recommendations regarding a restraints policy?

I would think, if they did, that following up with them would be the best place to start.

hippy18

Rock22 this is a copy of what the final report says. I have edited out certain details for privacy reasons.

Recommendation 4: The hospital should develop a policy on the management of challenging behaviour including the use of restraint techniques. ( Hospital) have stated that the “Restraint and Restrictive Practices Policy” is a complex policy to develop. It adds that policy development has been impacted by a number of issues over the last number of years, including the Covid-19 pandemic, the cyber-attack and the fire at Wexford General Hospital. ( Hospital ) state that a number of documents have been developed to provide guidance for staff on the management of behavioural and psychological symptoms of dementia and the management of behavioural issues. ( Hospital ) add that these guidance documents refer to the care of patients with dementia, however, they can also be adapted for use with other patients with behavioural issues, if necessary. ( Hospital ) has assured this office that work on this policy is currently ongoing and will continue until its completion and implementation at the hospital.

Analysis and findings of Recommendation 4: I am aware from my correspondence with ( hospital) that work on the Restraint and Restrictive Practices Policy is progressing, albeit slowly. In addition, I acknowledge that the issues to be addressed by this policy are complex and require consideration and input from various stakeholders, including Consultants and multidisciplinary teams. That said, I am aware that this matter has been ongoing for an extended period of time and while the hospital states that elements of other similar type policies can be applied, no specific policy, as identified in its recommendation, has yet been adopted. Therefore, in addition to my correspondence with ( the hospital ) I have raised my concern in relation to the lack of an overarching policy for all acute hospitals on the use of restraint and restrictive practices with various state agencies, including the Department of Health. The Department have stated that the concerns raised by this office have been taken on board for consideration by its policy unit...

As I said previously we had an amazing case worker who has done an amazing job in trying to fix the issues we raised but as it stands nothing is in writing and I would like to continue this as a concerned sister if possible or to speed up the process as I do believe we have raised a very valuable point regarding the care received in hospitals regarding the use of restraint.

bureau2009

Was this a HSE hospital?

Put your concerns, issues and questions in a letter to the Chair of the HSE. Copy this letter to the Deputy Chair. Send both by registered post. Ask that your letter be noted under "Board Correspondence".

This may not progress your issue. However it will create a record of putting all the issues concerning your sister's treatment right in front of those in charge of the HSE.

hippy18

Del2005 when this first happened we went to TDs no one thought what was happening to my sister was right and wouldn't want their family member going though anything similar but everyone directed us to the ombudsman which we did. I have thought TDs might be a way to go now we have the final report from the ombudsman so this is something I might look into.

As for the media I am unsure this is a route my family would like to take. It was a very difficult time for my family and even getting this final report it brings a lot of emotions up that are difficult to deal with. I would like to be a voice for my sister to the people that can make a difference in this situation I'm just not sure who that is now.

Peregrinus

This sounds appalling. I'm really sorry for your sister, and for you and your family.

I don't know if these people, or these people, would be any help. I think they both focus on advocating for the interests of specific existing patients, rather than on behalf of patients generally, which is where you are now. But, if nothing else, they might be able to put you in touch with more general patient advocacy groups who would know how to lobby effectively for change.

hippy18

bureau2009

*Put your concerns, issues and questions in a letter to the Chair of the HSE. Copy this letter to the Deputy Chair. Send both by registered post. Ask that your letter be noted under "Board Correspondence.

this took place in 2015 and the HSE was aware of my sister's case at the time but I have not contacted them regarding this issue since getting the final report from the ombudsman. It has taken over 6 years for our case to be closed, do you think I should still write a letter like you suggested? Apologies for sounding uneducated but by adding "board correspondence" what will this hopefully achieve?

Many thanks for the comment

So sorry your sister, you and your family went through this. It is shocking but not surprising. I wish you best of luck in your lobbying to all agencies you approach.

bureau2009

By putting your concerns in writing you are once again raising the issues of your sister's treatment and the implementation of relevant policies. Your are making this a live, and current issue.

Asking for your letter to be noted at the next Board meeting under Board Correspondence will ensure your letter is formally recorded and appropriate records are kept.

rock22

Lots of good advice already hippy18. I would again raise concerns with the Ombudsman as well as with the BEO and board of the HSE.

I also wonder if HIQA would have a role here. They could close the hospital, of they are not happy it is conforming to adequate standards.

UrbanFox

https://www.boards.ie/discussion/comment/121433545#Comment_121433545

+1 HIQA. OP should definitely talk to them.

LINK Home | HIQA

hippy18

Peregrinus thanks you ever so much for the links, I have emailed the second one as on the website they say they work with policy makers which I what I believe I need. Hopefully I'll get a response..

bureau2009 thank you for explaining this is something I might try i wasn't aware of this before today. I will try to compose a letter and follow your instructions.

rock22 and UrbanFox I did report this to hiqa sadly hiqa does not have any authority over Acute medical hospitals they again referred me to the HSE or the ombudsman. We had meetings with the HSE several over a period of a few years, I honestly don't remember every office or department we wrote too but I did contact every organisation I felt could help but it all mostly fell on deaf ears with their biggest sympathies on how my sister was treated, During one of the meeting with the hospital and member of the HSE after my sister had left the hospital over funding for further case, the person from the HSE became aware of what had happened to my sister and contacted me later on that day to express how sorry he was this happened, to reassure me my sister would not be placed back into that hospital and he would sort the funding for her future placement, he also added between him and me he felt we needed to "blow this out of the water" and passed on the contact details for a leigh gath confidential recipient and who I wrote too, I never heard back from this office but it was because of this letter a meeting was set up a few months later for us to express our complaints to the hospital which we did and they just brushed over stuff they did to my sister and mainly blamed my sister behaviour because of this I put in a complaint to the ombudsman. As you can imagine this has been exhausting at times because everyone recognises this policy needs to be put into place but the hse doesn't seem to be enforcing it. We can not change what happened to my sister I now except that and no manager in the hospital will lose their job over how they treated my sister which Is what i wanted originally to happen so we are left with just trying to make hospitals a little safer for people like my sister which with the help of the ombudsman I feel some changes the hospital made will make a difference for others and I am glad for this because no one deserves to be treated like her or us as a family.

I thank everyone who has commented and given advice and wished us well. I have some ideas and people I can contact which has been a massive help and it's very much appreciated.

rock22

@hippy18 "rock22 and UrbanFox I did report this to hiqa sadly hiqa does not have any authority over Acute medical hospitals they again referred me to the HSE or the ombudsman."

I am assuming that this is an HSE hospital. From HIQA website

https://www.hiqa.ie/guidance-providers/healthcare-services

"We monitor healthcare services provided or funded by the Health Service Executive (HSE)..... we do not currently have a legal remit to regulate or monitor providers of private healthcare services. "

Is it possible the hospital concerned is a private hospital? Otherwise I would suggest you contact them again and ask specifically if they have standards around the restraint of patients in an acute setting.

hippy18

Rock22 this is the reply I received from them when I sent a complaint into them about my sisters care. This was in 2015, I think they were the first department I contacted because I work in a nursing home and just thought hiqa would cover hospital as well. I have removed the hospital name but this is not a private hospital it is a university hospital in the south east.. the department they tell me to contact is the patient advocacy at the hospital which we did.

Dear

Thank you for contacting the Health Information and Quality Authority (the Authority) in relation to your sister’s care at

The Authority was established under the Health Act 2007 to set standards for health and social care services in Ireland and to monitor compliance with these standards. Under the Health Act 2007, the Authority does not have a remit to address individual concerns in relation to health and social care services.

However, each service provider has a statutory responsibility to respond to complaints, accordingly I would suggest that you contact.

Email:

Address:

Telephone:

You may also wish to contact an independent patient advocate to assist you in making your complaint. Advocacy is a support system that assists people to defend and promote their rights and responsibilities, access information and services and express their views and concerns. A list of patient advocacy groups is available at the following HSE website:

http://www.hse.ie/eng/services/yourhealthservice/feedback/services/

Additionally, you can obtain more information on how to complain about health and social care services in Ireland from: www.healthcomplaints.ie. You can also contact the HSE National Information Line on 1850 241 850.

The Office of the Ombudsman examines how public hospitals in Ireland handle complaints about their services. In particular this office looks at how well the Health Service Executive and public hospitals (including voluntary hospitals) listen to feedback and complaints and whether learning from complaints is used to improve the services that they provide. The Office of the Ombudsman can be contacted by telephone on 1890 223 030 or by email on ombudsman@ombudsman.gov.ie More information on their role and how to make a complaint is available at https://www.ombudsman.gov.ie/en/

Each individual’s experience of the health and social care service is an invaluable source of information to the Authority. The Authority reviews all information received about the safety and quality of services, as it could indicate that a service provider may not be complying with standards and or regulations. The Authority will use the information you have provided to inform the Authority’s ongoing monitoring programmes.

It is the policy of the Authority to hold your contact details and the information provided in confidence. Personal details or material facts which may reveal identity will not be disclosed without first seeking your permission.

I would like to thank you, once again, for bringing this matter to the attention of the Authority.

Yours sincerely,

Judy Gannon

Authorised Person

Health Information and Quality Authority

Georges Court,

Georges Lane

Dublin 7

Ph: 01 8147400

E-Mail: concerns@hiqa.ie

Web: www.hiqa.ie

carfinder

I doubt this was/is a straightforward issue for the hospital and I very much doubt that there was a motive of punishing the patient (i know this is not being alleged in any case). Presumably there was a need for use of restraints in this case and the OP disagrees with the particular restraints used - fair enough, nobody wants to see a loved one in that scenario.

The 'failing' appears to be the lack of a formal restraints policy and a risk assessment to align with appropriate restraints.

I presume that the hospital has to balance the safety of its staff against the 'comfort' of the patient and no doubt the Ombudsman has found against the hospital for not having a written policy generally and a specific risk assessment for this patient.

No doubt the ultimate villain here is the acute brain injury suffered by the patient which left her requiring acute medical care requiring restraints.

The original motive of the OP to see people lose their jobs appears to have been excessive, notwithstanding he/she now accepts that won't happen

It’s always very upsetting to see a loved one having brain issues that affect behaviour and it can be quite common in some variants of dementia. I was visiting my 92 year old aunt in her nursing home recently, who has the good fortune of being very placid. However a fellow resident had a Tourette’s-like syndrome, his poor unfortunate wife very embarrassed by his change in behaviour from being a mild-mannered polite man to cursing and blinding all around him., also throwing a fist when his mind tells him it’s needed.

We were chatting with what is the kindest nurse I have ever met, a girl from Lesotho, who was telling us about a course in self-defence she and other staff members were being sent on. How to restrain patients effectively and avoid injury to caregiver and patient alike. She said she loves all her patients no matter what, it’s not their fault that nature has bestowed brain injuries and illnesses onto them.

hippy18

carfinder

At no point did I request anyone lose their jobs but be sure I did really wish this one person would. I don't expect you to understand why because I have not expressed what happened but I have every right to hope someone like that never works around vulnerable people again! You need to have compassion working within a hospital and If you don't work somewhere else.

The restraints policy is only 1 part of our case with the ombudsman and this hospital has already attempted they were wrong in using them in the manner they did and apologised for it so if you don't mind please don't Presume they were needed, it is because of this sort of backwards thinking a restrains policy is needed to protect my sister from people like you thinking this sort of treatment is needed! My sister did nothing wrong ,was she hard to manage? Yes you bet she was, a virus infection ate half of her brain away she never had the cognitive ability to understand what was happening around her, no one had the right to treat her that way especially people who claim to be care providers..

If a care provider isn't educated in caring for someone with reactive behaviour and order staff to put themselves at unnecessary risk to speed up a job ( caring for someone ) who is to blame for the safety of the staff? I don't think it's the brain injury I think it's the person who made that decision to use physical restraints in the first place

Is it wrong to expect a care provider to try a more compassionate approach before they order physical restraints being used? I mean literally sitting with the patient for 20 minutes talking to them instead of using physical restraints?

This hospital had nothing in place to protect my sister that is not right! I agree staff need to be protected but what about the patients who protects them from abusive hospitals? No one does, my sister was lucky because she had us as a family and we were able to speak for her but what about other people who don't have family who is protecting them?

The only villains in this story is the staff at the acute medical hospital that cared for my sister and the HSE for not having proper policies in place that a family like mind could of used when abusive practices were taken place..

hippy18

[Deleted User]

My sister had/has no control over her behaviour it's just a very sad side effect from her injury she can't help it.. during this time there was no staff trained how to deal with my sister so she was treated like a thug, according to the ombudsman some changes have happened and more training is expected now around how to treat patients with reactive behaviour in this hospital, i hope it's true I just don't want this happening again to my sister. With all her reactive behaviour she is still caring, sweet and really empathetic to people, her brain injury just made it really hard to regulate her emotions.

I've worked in a nursing home for over 20 years I think this is the reason I'm struggling a bit the rules in hospitals are so different to nursing homes , I understand it's a totally different situation and care levels are different but I don't understand why people in hospitals don't need safeguarding the same as nursing homes both are vulnerable to abuse or neglect especially regarding being physically restrained..

I used to be mortified by my sister she is a completely different person now because of her injury and acts completely different but over the years she has come along so much it's not as bad now. My sister is able to regulate her emotions better now it's taken a few years but she does get better all the time.

carfinder

https://www.boards.ie/discussion/comment/121450356#Comment_121450356

I stated that your original motivation was lose their jobs. You literally said "We can not change what happened to my sister I now except that and no manager in the hospital will lose their job over how they treated my sister which Is what i wanted originally to happen... " . So you originally wanted managers to lose their jobs but now you are repositioning that you never asked for anyone to lose their job - youre being pretty disingenuous to say the least!

It is not backward thinking to expect that staff safety is prioritised over patient comfort in a scenario where a patient can cause injury to staff if not restrained. Your apparent balancing of patient comfort against staff safety is unrealistic- you suggested sitting with the patient for 20 minutes - is this required every time there is a necessary interaction? Like every meal, every nappy change, every medical exam, every day? Maybe we have infinite funds and can afford such treatment or maybe we have a very stretched healthcare system without the budget to employ people to spend 20 minutes calming a patient every time they have to be engaged with - and inan acute care hospital no less.

hippy18

carfinder

Do you work in the south east hospital I'm on about? Are you aware of our case? You come across as someone that might have worked for this hospital, no compassion and very judgemental on the patients, if you dont I recommend applying for a job I'm sure you'd fit in there nicely and will make management roll in no time...

hippy18

carfinder I don't understand why I'm disingenuous for hoping the person who ordered staff to be abusive to my sister lose their job? Of course I'm not telling the full story on here I stated that on my original question, you are getting only what I chose to share with people. My original question had nothing to do with the care my sister received in the hospital, my question was how do I get a restrains policy into all acute medical hospitals, unless you can help with my original question I suggest you stop commenting on here, your uneducated opinion doesn't help my sister or people like her..

rock22

Hi hippy from your first post @hippy18 "I am just wondering if anyone can advise me on how someone like me a complete no body ensures that the HSE does actually implement restraints policies into acute medical settings? " .

I took this to mean that your correspondence was around the creating and implementation of a policy nationwide. And I believe that HIQA could has an influence if there is an Ombudsman recommendation

https://www.boards.ie/discussion/comment/121442843#Comment_121442843

But in the reply from HIQA, they refer to

"Under the Health Act 2007, the Authority does not have a remit to address individual concerns in relation to health and social care services. However, each service provider has a statutory responsibility to respond to complaints, accordingly I would suggest that you contact."

From this, I am taking it that your complaint to HIQA was specifically about the treatment of your sister. Which , rightly, HIQA has said it is not the correct authority for that complaint. However it does have a role in ensuring adherence to standards in our health system.

My advice, you need to separate out the treatment of your sister from the general point around lack of policy on restraints. The former you must pursue with the hospital/HSE or Ombudsman directly. The latter, the lack of policy , you should again address to HIQA.

Sorry for the poor treatment your sister received.

hippy18

Rock 22

Thank you ever so much for your reply. I can'l not find my original concern to hiqa but when I first contacted hiqa I did most likely speak mainly about the types of restraints the hospital were using on my sister and her treatment by the hospital but wasn't directly about the restraints policy I don't think and I understand what you are saying about separating the two issues and contacting them again regarding the restraints policy issue on its own. I will do this and see what they say. What harm can it do..

I don't believe we will get any further regarding my sister's treatment/care with the HSE or the ombudsman because the hospital have admitted they were wrong and apologised, as much as it's hard to accept we don't really have much choice, my sister doesn't remember what happened to her, it's a blessing, it's just really hard to forget as her family.

According to the ombudsman the hospital have a list of stuff they have put into place around the issues my family raised and if all these things are actually implemented the hospital most likely will be a much safer place for people like my sister and families won't have to go though what mine did with no support, I just have no faith in any organisation actually making sure these are being implemented now the ombudsman has closed our case..

Thank you again for taking the time to help and for the suggestions I do really appreciate it, if I get any progress I will come back to update this post..

hippy18

I just thought I'd update my post, since I last posted I contacted hiqa, the HSE and the department of health just asking them who regulates the use of restraints in acute medical hospitals and what repercussions do hospitals face if they use them inappropriately. I did not say what had happened just asked in general. I've only got a response from hiqa and the HSE, both departments quoted the mental health act which I am aware of and I was informed these are the national guidelines but not enforced by anyone. Both departments wanted to speak on the phone which I declined as I want to keep all correspondence in writing.

I am still waiting for a response from the HSE since I declined to speak on the phone but hiqa replied and said without context to the questions they suggested ringing a hospital solicitor, I replied and went into more detail what happened to my sister and ask what safeguarding is in place now to protect her from it happening again if she needed future acute medical care. I also asked if the hospital doesn't meet the national standards does the hospital face any repercussions from their department or any other organisation in Ireland or was it solely the responsibility of the family to stop hospitals using restraints inappropriately. This is the response

Dear

Thank you for reverting with additional information to assist with your query. I am sorry to read of your sister and your families experience with the hospital.

As Sarah has advised our regulatory remit is set out within the Health Act 2007, as amended and we have a regulatory remit to monitor acute and community hospitals against the National Standards. Our regulatory remit is underpinned in a rights based approach and is a fundamental element of the National Standards for Safer Better Healthcare. HIQA currently has no enforcement powers in relation to public hospitals – we inspect and publish reports that contain the findings of the inspection.

If you are happy to share the name of the hospital I will bring this to the attention of my colleagues in the healthcare team and we can use the information to inform lines of enquiry on our inspections. In the meantime I will also raise your concerns in relation to the lack of policy and or procedure in relation to the use of restrictive practices within acute care facilities.

In relation to your concerns about future admissions to hospital and what your sister might expect and or experience I would suggest that you contact the HSEs National Quality and Patient Safety Directorate – Dr. Orla Healy is the National Clinical Director – this team build quality and patient safety capacity and capability within practice https://www2.healthservice.hse.ie/organisation/nqpsd/pst/. The team can be contacted by email: nqps@hse.ie.

If you would like to contact me by phone and discuss any of the above further my direct dial number is

Kind regards

Regional Manager (Information Management Unit)

Health Information and Quality Authority

George’s Court | George’s Lane | Smithfield | Dublin 7 | D07 E98Y

Telephone: 01 814 7400 or Direct Dial:

Email

I have looked over the website National Quality and Patient Safety Directorate but I'm not 100% sure how they can help me which I'm hoping someone else might be able to help with I understand they work towards patient safety but how does me contacting them get a restraints policy implemented?

I plan on sharing the hospital name with hiqa I don't see what harm it can do but I am trying to work out again by me doing this how does this help with implementing this policy if hiqa has no power to enforce anything? Like what does her raising this concern with the healthcare team actually mean in the roll hiqa have in hospital I'm a little confused by it.

Gorteen

The reference to the Mental Health Act and the following;

"I've only got a response from hiqa and the HSE, both departments quoted the mental health act which I am aware of and I was informed these are the national guidelines but not enforced by anyone."

The people who spoke to you are either ill-informed or trying to fudge the issue. Mental Health services are inspected intensively at least one per year and one key focus on the inspection process is the compliance (where 100% compliance is expected) with the Code of Practice on the use of Physical Restraint (revised in January 2023).

In relation to your particular case, I am appalled that you remain dissatisfied with the HSE response.

In my experience in the HSE, I would suggest that the more 'agitation' you cause, the better: whether it be through HIQA, Ombudsman's office, Patient Advocacy Service, Parliamentary Questions (through your TDs), writing directly to the Minister for Health, local political representatives on the HSE Regional Health Forums (Google to see your local reps), questions in the Dail, etc, etc.

In my experience, you need to become such a "pain in the arse" for the HSE to understand that you won't be fobbed off with inane reassurances about "lessons will be learned", "things will change going forward", etc...

hippy18

@Gorteen many thanks for the reply. Yes I figured the response from hiqa isnt much help in what I'm trying to achieve. I appreciate other peoples experiences can better the healthcare system in Ireland but I don't think it's done by printing more guidelines that hospitals can choose not to follow. I will do as they suggested as if nothing else it keeps people talking about our situation. I didn't expect to get much help from hiqa, over the years I don't even remember being referred to their department when I raised our concern to anyone it was contact the hospital, HSE or ombudsman if you aren't satisfied with the first two.

This is how I have sent my enquiry to hiqa, the HSE and the department of health

To who it may concern

I am enquiring how the use of restraints and restricted practices are regulated in acute medical hospitals in Ireland?

The HSE reply

The Mental Health Commission (MHC) is the regulator for mental health services in Ireland. The MHC's main functions are to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to protect the interests of persons admitted and detained under the Mental Health Act, 2001 (the '2001 Act').

The Health Information & Quality Authority (HIQA) promotes safety and quality in healthcare services in Ireland. To do this, they inspect hospitals and other healthcare providers and talk to patients, staff and managers to determine if healthcare providers are meeting national standards.

Any restrictive practice used within an Approved Centre is regulated under the Mental Health Act. The use and application of any restrictive practice must be in accordance with rules and regulations as laid out by the Mental Health Commission. Full details can be found via the following link: pulse.ly/yvggfocqt6

The reply from hiqa

Dear

Thank you for contacting the Health Information and Quality Authority (HIQA). HIQA was established under the Health Act 2007, as amended, to promote safety and quality in the provision of health and personal social services for the benefit of the health and welfare of the public. HIQAs regulatory role is to regulate designated centres for older people, people with a disability and special care units. HIQA also regulates medical ionising radiation exposure and monitors standards in acute and community hospitals and some children’s social care services.

With regards to your query relating to the regulation of restricted practices in acute medical hospitals, please note that restrictive practices are not currently regulated by law in Ireland. However, HIQA and the Mental Health Commission have jointly published National Standards for Adult Safeguarding which do set out some information in respect of restrictive practices that is applicable to healthcare settings. I have provided a link to these Standards for you here. In addition, HIQA have also developed guidance for health and social care services on implementing a human-rights based approach to care and support for adults. This guidance also includes information on restrictive practices and a copy of this guidance can be accessed by clicking here.

HIQA does welcome feedback from members of the public in respect of services we regulate and monitor. Should you wish to give feedback about a specific service, you can do so by calling (01) 814 7679 or by email to concerns@hiqa.ie , where a member of the team will be happy to speak with you.

Thank you once again for contacting the Health Information and Quality Authority.

Kind regards,

Receipt of Information Quality Lead | Information Handling Centre

Health Information and Quality Authority

George’s Court | George’s Lane | Smithfield | Dublin 7 | D07 E98Y

Tel: 01 814 7679

Website: www.hiqa.ie

The department of health has not responded to the question tho I'm starting to feel this is the department I need to work on the hardest, these are the people who make the rules in Ireland

I had composed an email to Mary butler because when this was happening to my sister my father and I went to speak to several TDs and she is a local td for us. She's gone up the food chain since then and I suspect now I need to contact Hildegarde Naughton? It says on the website, Hildegarde Naughton is Minister of State at the Department of the Taoiseach with special responsibility as Government Chief Whip; and the Department of Health with special responsibility for Public Health, Wellbeing and the National Drugs Strategy.

I am right in thinking because she has a special responsibility for public health she is responsible for overseeing acute medical hospitals?

Since I have posted this question on here I have spoke to my family and they are happy for me to try anything possible to get the policy implemented, if making a petition or even going to a media outlet if the HSE/government won't listen to us can help that might be an option we might try. I wanted to get it in writing first that no one is regulating the use of restraints in hospitals in Ireland which hiqa have stated in their first reply back to me. I do believe the public would get behind us if I explained what happened, I don't believe the general public realise if their mother,sister, daughter or even grandmother gets admitted into any acute medical hospital that hospital can use opposite sex agency security guards to restrain them while personal care is being given even if the patient isn't a threat to themselves or anyone else, the hospital are under no obligation to follow any guidelines set out in the mental health act, no dignity or respect for the patient has to be upheld they can discard that if and when they please, they do not have to listen to any concerns raised from the family regarding this treatment, they don't even need to inform the family they are using restraints in that manner it is purely down to the discretion of the admin staff if your loved one is going to be mishandled, abused, neglected not a consultant not a doctor or a nurse a member of the admin staff makes that decision. I think if the general public were aware of this I don't think people would like the hospitals having so much unregulated power over their loved ones.

Gorteen

The info on the Mental Health Commission is irrelevant to your query because it does not relate to "an Approved Centre". Disregard that info, other than the Code of Practice which could be a template or a guide to "ordinary" hospital environments.

HIQA should be more proactive in this area but aren't. I agree, focusing on the responsible Ministers (if in doubt, or getting the run around) go directly to the Minister for Health. Use local TDs to ask Dail questions.